title: Rigid sternal fixation improves postoperative recovery.
abstract: BACKGROUND
  During the past five years, ridged sternal fixation has been utilized for sternal closure after cardiac surgery. It is known that this procedure provides better sternal stability; however, its contribution to patient recovery has not been investigated.
  
  
  METHODS
  Retrospective chart review was conducted for patients who underwent CABG and/or valve surgery in our institution between 2009 and 2010. Preoperative, perioperative, and follow-up data of patients with ridgid fixation (group R, n=89) were collected and compared with those patients with conventional sternal closure (group C, n=133). The decision regarding the sternal closure method was based on the surgeon's preferences. Univariate followed by multivariate analyses were performed to evaluate the dominant factor of sternal lock usage and to evaluate postoperative recoveries. The factors included in the analyses were; age, sex, coronary risk factors, urgency of surgery, ejection fraction, coronary anatomy, preoperative stroke, renal function, and preoperative presence of heart failure. All statistical analyses were performed by JMP software.
  
  
  RESULTS
  Group R was younger (62 ± 9 in group R vs 69 ± 11 in group C, p<0.0001) than group C, more male dominant (61% vs 49%, p=0.0452), had a lower percentage of patients undergoing redo-surgery (2.2% vs 9.0%, p<0.0418), was more likely to be used in isolated coronary artery bypass grafting (71% vs 46%, p=0.0002), more often to be used for large patient (body mass index, BMI greater than 30) (58% vs 37%. P=0.0045), and patients were more likely to have a low EuroSCORE (2.6 ± 2.3 vs 4.4 ± 2.7). Intubation time (13 ± 20 hours vs 39 ± 97 hours, p=0.0030), ICU stay (58 ± 40 hours vs 99 ± 119 hours, p=0.0003), and postoperative length of stay (7.0 ± 3.7 days vs 8.4 ± 4.7 days, p<0.0141) were significantly shorter in group R than group C. Multivariate analyses showed ridged sternal fixation was the most dominant factor affecting intubation time and ICU stay.
  
  
  CONCLUSIONS
  Rigid sternal fixation systems were more frequently applied to low risk young male patients. Among these selected patients, ridgid sternal fixation can contribute to early patient recovery.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirose
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamane
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Youdelman
authors.forename: Linda
authors.initials: L
authors.lastname: Bogar
authors.forename: James T
authors.initials: JT
authors.lastname: Diehl