title: Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage.
abstract: To evaluate sternal healing, complications, and costs after sternotomy closure with rigid plate fixation or wire cerclage.
  
  
  
  This prospective, single-blinded, multicenter trial randomized 236 patients at 12 US centers at the time of sternal closure to either rigid plate fixation (n = 116) or wire cerclage (n = 120). The primary endpoint, sternal healing at 6 months, was evaluated by a core laboratory using computed tomography and a 6-point scale (greater scores represent greater healing). Secondary endpoints included sternal complications and costs from the time of sternal closure through 6 months.
  
  
  
  Rigid plate fixation resulted in better sternal healing scores at 3 (2.6 ± 1.1 vs 1.8 ± 1.0; P < .0001) and 6 months (3.8 ± 1.0 vs 3.3 ± 1.1; P = .0007) and greater sternal union rates at 3 (41% [42/103] vs 16% [16/102]; P < .0001) and 6 months (80% [81/101] vs 67% [67/100]; P = .03) compared with wire cerclage. There were fewer sternal complications through 6 months with rigid plate fixation (0% [0/116] vs 5% [6/120]; P = .03) and a trend towards fewer sternal wound infections (0% [0/116] vs 4.2% [5/120]; P = .06) compared with wire cerclage. Although rigid plate fixation was associated with a trend toward greater index hospitalization costs ($23,437 vs $20,574; P = .11), 6-month follow-up costs tended to be lower ($9002 vs $13,511; P = .14). As a result, total costs from randomization through 6 months were similar between groups ($32,439 vs $34,085; P = .61).
  
  
  
  Sternotomy closure with rigid plate fixation resulted in significantly better sternal healing, fewer sternal complications, and no additional cost compared with wire cerclage at 6 months after surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, Mo. Electronic address: Kallen2340@aol.com.
authors.forename: Keith B
authors.initials: KB
authors.lastname: Allen
authors.affiliation: Department of Cardiothoracic Surgery, Emory University, Atlanta, Ga.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Department of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Department of Cardiothoracic Surgery, University of Louisville, Louisville, Ky.
authors.forename: Kendra J
authors.initials: KJ
authors.lastname: Grubb
authors.affiliation: Department of Cardiothoracic Surgery, Allina Health, Saint Paul, Minn.
authors.forename: John
authors.initials: J
authors.lastname: Grehan
authors.affiliation: Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY.
authors.forename: Nirav
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Cardiothoracic Surgery, Temple University, Philadelphia, Pa.
authors.forename: T Sloane
authors.initials: TS
authors.lastname: Guy
authors.affiliation: Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Fla.
authors.forename: Kevin
authors.initials: K
authors.lastname: Landolfo
authors.affiliation: Department of Cardiothoracic Surgery, Franciscan St. Francis Health, Indianapolis, Ind.
authors.forename: Marc
authors.initials: M
authors.lastname: Gerdisch
authors.affiliation: Department of Cardiothoracic Surgery, University of Toledo, Toledo, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Bonnell
authors.affiliation: Department of Cardiology, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D001860:Bone Plates / Q000191:economics; D001864:Bone Wires / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D016037:Single-Blind Method; D056346:Sternotomy; D013249:Sternum / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D014945:Wound Healing
keywords: cost effectiveness; rigid plate fixation; sternal closure; sternal complication; sternal healing; sternal wound infection; wire cerclage