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Rigid Sternal Fixation Versus Modified Wire Technique for Poststernotomy Closures: A Retrospective Cost Analysis

Park, Jiwon Sarah MD*; Kuo, Jennifer H. MD; Young, J. Nilas MD; Wong, Michael S. MD*

doi: 10.1097/SAP.0000000000000901
Reconstructive Surgery

Background: Rigid sternal fixation (RSF) has been shown to reduce sternal wound complications in high-risk patients. However, the higher initial cost continues to deter its use. This study evaluates the cost of caring for high-risk sternotomy patients who underwent RSF compared with those who underwent sternal closure with a modified wire technique (MWT).

Methods: A retrospective single institution review of high-risk patients who underwent MWT (n = 45) and RSF (n = 30) for primary sternal closure from 2006 to 2009 was conducted. Total hospital cost, revenue, and net cost associated with surgery and subsequent care were analyzed.

Results: Overall rates of wound dehiscence and wound infections (superficial and deep) were higher in MWT patients (n = 14, 13, and 7, respectively) than RSF patients (n = 3, 2, and 0, respectively; P < 0.05). Modified wire technique patients also required more operations (mean ± SEM: 0.4 ± 0.1 vs 0.1 ± 0.1; P = 0.045), and had longer follow-up time (55.0 ± 9.1 vs 13.4 ± 10.5 days; P = 0.004). Overall, the hospital suffered a greater loss caring for MWT patients (US $18,903 ± 2,160) than RSF patients (US $8,935 ± 2,647). Modified wire technique patients who developed a complication had higher costs associated with their operative hospitalization, outpatient care, and home health than RSF patients (total net loss: US $41,436 ± 7327 vs US $10,612 ± 4,258; P = 0.034).

Conclusions: In high-risk patients, RSF is associated with lower rates of infections, including the “never event” mediastinitis, compared with MWT. Moreover, despite the initial higher cost, RSF affords an overall lower cost of care compared with MWT in patients at high-risk for developing sternal complications.

From the *Division of Plastic Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, CA; †Section of Endocrine Surgery, Department of Surgery, New York-Presbyterian Columbia University, New York, NY; and ‡Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis Medical Center, Sacramento, CA.

Received May 4, 2016, and accepted for publication, after revision August 3, 2016.

J.S.P. participated in the analysis and interpretation of data, and writing the article. J.K. participated in the conception and design, analysis and interpretation of data, partial writing of the article and critical revision of the article. J.N.Y. participated critical revision of the article. M.S.W. participated in the conception and design, analysis and interpretation of data, critical revision of the article.

Conflicts of interest and sources of funding: none declared.

This work was partially presented at the 2011 56th Annual Plastic Surgery Research Council meeting in Louisville, KY with a published abstract in the PRS supplement (Kuo JH, Young N, Wong MS. Cost Analysis of Rigid Sternal Fixation versus Modified Wire Techniques for Primary Sternal Closure of High Risk Sternotomy Patients. Plastic and Reconstructive Surgery 2011;127(5S):47.

Reprints: Michael S. Wong, MD, 2221 Stockton Blvd, Suite 2123, Sacramento, CA 95817. E-mail: mswong@ucdavis.edu.

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