title: Nitinol flexigrip sternal closure system and chest wound infections: insight from a comparative analysis of complications and costs.
abstract: BACKGROUND
  We sought to assess the efficiency of two different sternal closure techniques in preventing sternal wound complications (SWC). A cost analysis was also considered.
  
  
  METHODS
  Between January 2008 and April 2010, 1,644 consecutive cardiac surgery patients who underwent cardiac surgery in our institute were prospectively collected. A total of 1,072 patients received a standard parasternal wiring technique (group A), and 572 patients received a new method of sternal closure based on the use of thermoreactive nitillium clips (Flexigrip; Praesidia SRL, Bologna, Italy [group B]). We investigated, by a propensity matched analysis, whether the use of standard or nitinol clip closure would impact on sternal wound outcome.
  
  
  RESULTS
  In all, 464 patients of each group were matched for 17 available risk factors. Overall incidence of SWC was significantly higher in group A (4.1% versus 1.7%; p=0.03). Sternal surgical revision to treat a thoracic instability was required in a significantly higher number of patients in group A (9 patients, 1.9%) and in none of group B (p=0.004). The incidence of sternal instability, secondary to wound infection, was significantly lower in group B (p=0.05). Overall costs were €7,407,296 and €6,896,432 in group A and group B, respectively. Thus, nitinol clip closure technique offered a €510,864 cost saving compared with standard steel wiring technique.
  
  
  CONCLUSIONS
  The Flexigrip assured a lower incidence of SWC. The use of the nitinol clip favored an improved sternal closure technique preventing mediastinitis. Additionally, the nitinol clip system proved to be cost effective in cardiac surgery.
authors.affiliation: Department of Cardiac Surgery, University of Padua, Medical School of Padua, Padua, Italy.
authors.forename: Jonida
authors.initials: J
authors.lastname: Bejko
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.forename: Marco
authors.initials: M
authors.lastname: De Franceschi
authors.forename: Roberto
authors.initials: R
authors.lastname: Bianco
authors.forename: Massimo
authors.initials: M
authors.lastname: Castoro
authors.forename: Tomaso
authors.initials: T
authors.lastname: Bottio
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000368:Aged; D000497:Alloys; D001864:Bone Wires; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D012086:Reoperation / Q000191:economics*; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000191:economics / Q000601:surgery*; D013530:Surgical Wound Infection / Q000191:economics / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects*
chemical_list: D000497:Alloys; C013616:nitinol