Rigid sternal fixation versus modified wire technique for poststernotomy closures: A retrospective cost analysis

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

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)537-542
Number of pages6
JournalAnnals of Plastic Surgery
Volume78
Issue number5
DOIs
StatePublished - 2017

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Costs and Cost Analysis
Mediastinitis
Medical Errors
Sternotomy
Hospital Costs
Wounds and Injuries
Wound Infection
Ambulatory Care
Hospitalization
Health
Infection

Keywords

  • Cost analysis
  • Rigid sternal fixation
  • Sternotomy
  • Wire cerclage

ASJC Scopus subject areas

  • Surgery

Cite this

Rigid sternal fixation versus modified wire technique for poststernotomy closures : A retrospective cost analysis. / Park, Jiwon Sarah; Kuo, Jennifer H.; Young, J Nilas; Wong, Michael S.

In: Annals of Plastic Surgery, Vol. 78, No. 5, 2017, p. 537-542.

Research output: Contribution to journalArticle

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abstract = "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.",
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