Outcomes of rigid fixation compared to wire closure after median sternotomy a systematic review and meta-analysis.

Abstract

Introduction: Wire closure is linear and provides a single point of support, while rigid fixation provides two-dimensional support and acts as an additional skeletal brace that holds the two hemisternum together. This property avoids the factors that make the wire closure unstable. This study aims to compare the outcomes of rigid fixation with wire closure to study the difference in recovery time, pain scores, and sternal complications.

Methods: Prospective protocol registration was done, and electronic databases were searched without using any search filters. Screening was performed by independent reviewers, and data was extracted from selected studies. Heterogeneity was assessed by the I ² test, the effect model was chosen accordingly, and the effect measure was chosen as appropriate. Forest plots and funnel plots were used to give visual feedback.

Results: The rigid fixation group had better healing scores at 3 months (MD: 0.8; 95% CI: 0.59-1.01; n = 376; I ² = 0%; P = <0.00001) and at 6 months (MD: 0.71; 95% CI: 0.23-1.20; n = 376; I ² = 71%; P = 0.004). The rigid fixation group had a better pain score at 3 months and had a lesser incidence of sternal dehiscence. However, rigid fixation group took 2.91 minutes longer for closure and had a 1.02-day shorter hospital stay on average.

Conclusion: Rigid fixation was found to be superior to the wire cerclage in regard to shorter hospital stay duration, sternal healing scores, postoperative pain up to 3 months, and sternal dehiscence complication among the obese population.