New sternal closure methods versus the standard closure method: Systematic review and meta-analysis

Detalhes bibliográficos
Autor(a) principal: Cataneo, Daniele C. [UNESP]
Data de Publicação: 2019
Outros Autores: Dos Reis, Tarcisio A. [UNESP], Felisberto, Gilmar [UNESP], Rodrigues, Olavo R., Cataneo, Antônio J. M. [UNESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://dx.doi.org/10.1093/icvts/ivy281
http://hdl.handle.net/11449/187395
Resumo: Objectives: This study aimed to evaluate, by means of a systematic review, the efficiency of new methods for sternal closure in order to prevent sternal wound complications after sternotomy. Methods: The method of study was a systematic review of randomized clinical trials. We included studies that used rigid plates, thermoreactive clips, cables and flat wires, in comparison with the standard closure method. Patients included adults, regardless of gender and race. Results: Seven clinical trials were included involving 1810 patients. Five trials were carried out in the USA, 1 in Australia and 1 in Italy, and the trials include both male and female patients. The included studies compared conventional sternal closure with new closure methods (rigid plate, thermoreactive clips, cables and flat wires). The new sternal closure methods make little or no difference compared to the standard closure when we analyse deep sternal wound infection [risk ratio 0.38, 95% confidence interval (CI) 0.02-7.63; I2 = 74%; 5 studies], superficial wound infection (risk ratio 1.34, 95% CI 0.46-3.92; I2 = 11%, 3 studies) and death (risk ratio 1.16, 95% CI 0.42-3.21; I2 = 0%, 3 studies), but pain score was lower in new sternal closure methods (mean difference -0.57, 95% CI -0.98 to -0.16, I2 = 0%, 3 studies). There were no meta-analyses of sternal union, hospital stay, reoperation or mechanic ventilation time because of the high heterogeneity between the studies in terms of these outcomes. Conclusions: New sternal closure methods probably make little or no difference regarding the prevention of sternal complications in the postoperative period when compared to the standard closure method.
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spelling New sternal closure methods versus the standard closure method: Systematic review and meta-analysisMedian sternotomyRigid fixationSternal closureSternal complicationsWire cerclageObjectives: This study aimed to evaluate, by means of a systematic review, the efficiency of new methods for sternal closure in order to prevent sternal wound complications after sternotomy. Methods: The method of study was a systematic review of randomized clinical trials. We included studies that used rigid plates, thermoreactive clips, cables and flat wires, in comparison with the standard closure method. Patients included adults, regardless of gender and race. Results: Seven clinical trials were included involving 1810 patients. Five trials were carried out in the USA, 1 in Australia and 1 in Italy, and the trials include both male and female patients. The included studies compared conventional sternal closure with new closure methods (rigid plate, thermoreactive clips, cables and flat wires). The new sternal closure methods make little or no difference compared to the standard closure when we analyse deep sternal wound infection [risk ratio 0.38, 95% confidence interval (CI) 0.02-7.63; I2 = 74%; 5 studies], superficial wound infection (risk ratio 1.34, 95% CI 0.46-3.92; I2 = 11%, 3 studies) and death (risk ratio 1.16, 95% CI 0.42-3.21; I2 = 0%, 3 studies), but pain score was lower in new sternal closure methods (mean difference -0.57, 95% CI -0.98 to -0.16, I2 = 0%, 3 studies). There were no meta-analyses of sternal union, hospital stay, reoperation or mechanic ventilation time because of the high heterogeneity between the studies in terms of these outcomes. Conclusions: New sternal closure methods probably make little or no difference regarding the prevention of sternal complications in the postoperative period when compared to the standard closure method.Division of Thoracic Surgery Department of Surgery Botucatu School of Medicine São Paulo State University UNESPPost-Graduation Program on Medicine Department of Surgery Botucatu School of Medicine São Paulo State University UNESPPost-Graduation Program on General Basis of Surgery Department of Surgery Botucatu School of Medicine São Paulo State University UNESPDepartment of Surgery Mogi das Cruzes UniversityDepartment of Surgery Botucatu School of Medicine São Paulo State University UNESPDivision of Thoracic Surgery Department of Surgery Botucatu School of Medicine São Paulo State University UNESPPost-Graduation Program on Medicine Department of Surgery Botucatu School of Medicine São Paulo State University UNESPPost-Graduation Program on General Basis of Surgery Department of Surgery Botucatu School of Medicine São Paulo State University UNESPDepartment of Surgery Botucatu School of Medicine São Paulo State University UNESPUniversidade Estadual Paulista (Unesp)Mogi das Cruzes UniversityCataneo, Daniele C. [UNESP]Dos Reis, Tarcisio A. [UNESP]Felisberto, Gilmar [UNESP]Rodrigues, Olavo R.Cataneo, Antônio J. M. [UNESP]2019-10-06T15:34:52Z2019-10-06T15:34:52Z2019-01-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article432-440http://dx.doi.org/10.1093/icvts/ivy281Interactive Cardiovascular and Thoracic Surgery, v. 28, n. 3, p. 432-440, 2019.1569-92851569-9293http://hdl.handle.net/11449/18739510.1093/icvts/ivy2812-s2.0-85062080420Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengInteractive Cardiovascular and Thoracic Surgeryinfo:eu-repo/semantics/openAccess2021-10-22T19:03:32Zoai:repositorio.unesp.br:11449/187395Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-05T16:12:02.475881Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv New sternal closure methods versus the standard closure method: Systematic review and meta-analysis
title New sternal closure methods versus the standard closure method: Systematic review and meta-analysis
spellingShingle New sternal closure methods versus the standard closure method: Systematic review and meta-analysis
Cataneo, Daniele C. [UNESP]
Median sternotomy
Rigid fixation
Sternal closure
Sternal complications
Wire cerclage
title_short New sternal closure methods versus the standard closure method: Systematic review and meta-analysis
title_full New sternal closure methods versus the standard closure method: Systematic review and meta-analysis
title_fullStr New sternal closure methods versus the standard closure method: Systematic review and meta-analysis
title_full_unstemmed New sternal closure methods versus the standard closure method: Systematic review and meta-analysis
title_sort New sternal closure methods versus the standard closure method: Systematic review and meta-analysis
author Cataneo, Daniele C. [UNESP]
author_facet Cataneo, Daniele C. [UNESP]
Dos Reis, Tarcisio A. [UNESP]
Felisberto, Gilmar [UNESP]
Rodrigues, Olavo R.
Cataneo, Antônio J. M. [UNESP]
author_role author
author2 Dos Reis, Tarcisio A. [UNESP]
Felisberto, Gilmar [UNESP]
Rodrigues, Olavo R.
Cataneo, Antônio J. M. [UNESP]
author2_role author
author
author
author
dc.contributor.none.fl_str_mv Universidade Estadual Paulista (Unesp)
Mogi das Cruzes University
dc.contributor.author.fl_str_mv Cataneo, Daniele C. [UNESP]
Dos Reis, Tarcisio A. [UNESP]
Felisberto, Gilmar [UNESP]
Rodrigues, Olavo R.
Cataneo, Antônio J. M. [UNESP]
dc.subject.por.fl_str_mv Median sternotomy
Rigid fixation
Sternal closure
Sternal complications
Wire cerclage
topic Median sternotomy
Rigid fixation
Sternal closure
Sternal complications
Wire cerclage
description Objectives: This study aimed to evaluate, by means of a systematic review, the efficiency of new methods for sternal closure in order to prevent sternal wound complications after sternotomy. Methods: The method of study was a systematic review of randomized clinical trials. We included studies that used rigid plates, thermoreactive clips, cables and flat wires, in comparison with the standard closure method. Patients included adults, regardless of gender and race. Results: Seven clinical trials were included involving 1810 patients. Five trials were carried out in the USA, 1 in Australia and 1 in Italy, and the trials include both male and female patients. The included studies compared conventional sternal closure with new closure methods (rigid plate, thermoreactive clips, cables and flat wires). The new sternal closure methods make little or no difference compared to the standard closure when we analyse deep sternal wound infection [risk ratio 0.38, 95% confidence interval (CI) 0.02-7.63; I2 = 74%; 5 studies], superficial wound infection (risk ratio 1.34, 95% CI 0.46-3.92; I2 = 11%, 3 studies) and death (risk ratio 1.16, 95% CI 0.42-3.21; I2 = 0%, 3 studies), but pain score was lower in new sternal closure methods (mean difference -0.57, 95% CI -0.98 to -0.16, I2 = 0%, 3 studies). There were no meta-analyses of sternal union, hospital stay, reoperation or mechanic ventilation time because of the high heterogeneity between the studies in terms of these outcomes. Conclusions: New sternal closure methods probably make little or no difference regarding the prevention of sternal complications in the postoperative period when compared to the standard closure method.
publishDate 2019
dc.date.none.fl_str_mv 2019-10-06T15:34:52Z
2019-10-06T15:34:52Z
2019-01-01
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1093/icvts/ivy281
Interactive Cardiovascular and Thoracic Surgery, v. 28, n. 3, p. 432-440, 2019.
1569-9285
1569-9293
http://hdl.handle.net/11449/187395
10.1093/icvts/ivy281
2-s2.0-85062080420
url http://dx.doi.org/10.1093/icvts/ivy281
http://hdl.handle.net/11449/187395
identifier_str_mv Interactive Cardiovascular and Thoracic Surgery, v. 28, n. 3, p. 432-440, 2019.
1569-9285
1569-9293
10.1093/icvts/ivy281
2-s2.0-85062080420
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Interactive Cardiovascular and Thoracic Surgery
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 432-440
dc.source.none.fl_str_mv Scopus
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
instacron_str UNESP
institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
repository.mail.fl_str_mv
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