title: The number of wires for sternal closure has a significant influence on sternal complications in high-risk patients.
abstract: OBJECTIVE
  Sternal dehiscence and mediastinitis are rare but serious complications following cardiac surgery. The aim of this study was to investigate the influence of the number of sternal wires used for chest closure on sternal complications.
  
  
  METHODS
  From May 2003 to April 2007, 4714 adult patients received cardiac surgery in our institute. X-ray images of all patients were reviewed and the used wires were counted. Patients who received another material or longitudinal wiring technique according to Robicsek for chest closure were excluded from this analysis; thus 4466 patients were included into the final analysis. Figure-of-eight wiring was counted as two wires.
  
  
  RESULTS
  Sternal complications occurred in 2.4%, and hospital mortality with or without sternal complications were 2.8 and 2.7%, respectively (P = 0.60). Mean numbers of sternal wires were 7.8 in both patient groups with or without sternal complications (P = 0.79). Multivariate analysis revealed diabetes mellitus [odds ratio (OR) 1.54, 95% CI 1.01-2.34, P = 0.04], chronic obstructive pulmonary disease (OR 1.85, 95% CI 1.12-2.79, P = 0.01) and renal insufficiency (OR 1.70, 95% CI 1.11-2.59, P = 0.001) as significant risk factors for sternal complications. In high-risk patients, the use of less than eight wires was significantly associated with postoperative sternal complications.
  
  
  CONCLUSIONS
  Particularly in high-risk patients, careful haemostasis should be done and eight or more wires should be used to avoid sternal complications.
authors: Department of Cardiovascular Surgery, University of Düsseldorf, Düsseldorf, Germany. hkamiya88@yahoo.co.jp
authors: Hiroyuki
authors: H
authors: Kamiya
authors: Sameer S A
authors: SS
authors: Al-maisary
authors: Payam
authors: P
authors: Akhyari
authors: Arjang
authors: A
authors: Ruhparwar
authors: Klaus
authors: K
authors: Kallenbach
authors: Artur
authors: A
authors: Lichtenberg
authors: Matthias
authors: M
authors: Karck
mesh_terms: D000368:Aged; D001864:Bone Wires; D006348:Cardiac Surgical Procedures; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000209:etiology; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008480:Mediastinitis / Q000209:etiology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011859:Radiography; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects* / Q000401:mortality; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality