Wire cerclage versus rigid plate fixation: a retrospective cohort study and cost-benefit analysis on method of sternotomy closure following cardiac surgery
Dr. Vikash Dhanapathy1,2, Dr Mark Jones3, Dr Andrie Stroebel2,4, Dr Cheng He2,4
1Queensland Health, Brisbane, Australia, 2Griffith University, Australia, 3Bond University, Australia, 4Gold Coast University Hospital (GCUH), Australia
Background
This study compared the incidence of sternal complications between patients receiving rigid plate fixation versus wire cerclage in order to evaluate whether the higher initial cost of sternal plating may be offset by the cost of sternal complications averted.
Methods
A retrospective cohort analysis was performed on patients who underwent open cardiac surgery at an Australian tertiary centre between January 2019 to January 2023. Data was obtained from the Queensland Cardiac Outcomes Registry (QCOR). Incidence and morbidity of readmissions for sternal complications (including deep sternal wound infection and sternal malunion) were compared. Costs associated with each method of sternal closure were assessed.
Results
941 patients underwent sternotomy closure with wire cerclage and 67 patients received rigid plate fixation. Use of rigid plate fixation was associated with a reduced hospital length-of-stay (12 vs 14 days) and a comparable total admission cost. There were 37 readmissions for sternal wound complications, all of which occurred in the wire cerclage group. Majority of readmissions were attributed to deep sternal wound infection (n=21). Each readmission was associated with an average hospital length-of-stay of 17 days and total admission cost of $42,326 AUD. Factoring in cost of readmissions, average total cost per patient was $60,090 in the wire cerclage group, compared to $58,739 in rigid plate fixation group.
Conclusion
A clear cost-benefit was demonstrated in favour of rigid plate fixation. This benefit was observed, not just in high-risk patients, but across the general cardiac surgical population studied. As such, an argument is made for instituting rigid plate fixation as a first-line method of sternotomy closure.