title: A meta-analysis of computerized tomography scan for reducing complications following repeat sternotomy for cardiac surgery.
abstract: Cardiac reoperation carries additional risks compared with surgery in patients who are sternotomy-naïve. To identify if preoperative computerized tomography (CT) can reduce this risk, we performed a systematic review of the literature and meta-analysis. Literature search identified 178 studies of which 4 retrospective cohort studies incorporating 900 patients met inclusion criteria. There were no statistically significant differences in the risk of death, re-entry injury, renal failure or perfusion/ischaemic times. CT scan reduced the risk of stroke by 0.42 [95% confidence interval (CI): 0.19-0.93, P = 0.03] and a composite of major complications by 0.65 (95% CI: 0.47-0.88, P = 0.006). The use of preoperative cross-sectional imaging to reduce the risk of complications following cardiac reoperation is advocated.
authors.affiliation: Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, UK bilal.kirmani@nhs.net.
authors.forename: Bilal H
authors.initials: BH
authors.lastname: Kirmani
authors.affiliation: Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Brazier
authors.affiliation: Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Sanjeevan
authors.initials: S
authors.lastname: Sriskandarajah
authors.affiliation: Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Raed
authors.initials: R
authors.lastname: Azzam
authors.affiliation: Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Keenan
mesh_terms: D001027:Aortography / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D065840:Protective Factors; D012086:Reoperation; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: Cardiac; Cardiac surgery; Complications; Computerized tomography; Imaging; Meta-analysis; Reoperation; Statistics