{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:31:56Z","timestamp":1780392716982,"version":"3.54.1"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":1001,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,7,15]],"date-time":"2019-07-15T00:00:00Z","timestamp":1563148800000},"content-version":"tdm","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-aps.org"],"crossmark-restriction":true},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:p>\n          Background  Sternal rigid plate fixation (RPF) has been adopted in recent years in high-risk cases to reduce complications associated with steel wire cerclage, the traditional approach to sternal closure. While sternal RPF has been associated with lower complication rates than wire cerclage, it has its own complication profile that requires evaluation, necessitating a critical examination from a national perspective. This study will report the outcomes and associated risk factors of sternal RPF using a national database.<\/jats:p><jats:p>\n          Methods  Patients undergoing sternal RPF from 2005 to 2016 in the American College of Surgeons-National Surgical Quality Improvement Program were identified. Demographics, perioperative information, and complication rates were reviewed. Logistic regression analysis was performed to identify risk factors for postoperative complications.<\/jats:p><jats:p>\n          Results  There were 381 patient cases of RPF identified. The most common complications included bleeding (28.9%), mechanical ventilation &gt;48 hours (16.5%), and reoperation\/readmission (15.2%). Top risk factors for complications included dyspnea (odds ratio [OR], 2.672; P&lt;0.001), nonelective procedure (OR, 2.164; P=0.010), congestive heart failure (OR, 2.152; P=0.048), open wound (OR, 1.977; P=0.024), and operating time (OR, 1.005; P&lt;0.001).<\/jats:p><jats:p>\n          Conclusions  Sternal RPF is associated with increased rates of three primary complications: blood loss requiring transfusion, ventilation &gt;48 hours, and reoperation\/readmission, each of which affected over 15% of the study population. Smokers remain at an increased risk for surgical site infection and sternal dehiscence despite RPF\u2019s purported benefit to minimize these outcomes. Complications of primary versus delayed sternal RPF are roughly equivalent, but individual patients may perform better with one versus the other based on identified risk factors.<\/jats:p>","DOI":"10.5999\/aps.2018.01102","type":"journal-article","created":{"date-parts":[[2019,7,19]],"date-time":"2019-07-19T01:00:47Z","timestamp":1563498047000},"page":"336-343","update-policy":"https:\/\/doi.org\/10.5999\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Surgical outcomes of sternal rigid plate fixation from 2005 to 2016 using the American College of Surgeons-National Surgical Quality Improvement Program database"],"prefix":"10.1055","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4301-1407","authenticated-orcid":false,"given":"Bao Ngoc N.","family":"Tran","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5267-1530","authenticated-orcid":false,"given":"Austin D.","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9941-3128","authenticated-orcid":false,"given":"Melisa D.","family":"Granoff","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0824-1709","authenticated-orcid":false,"given":"Anna Rose","family":"Johnson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parisa","family":"Kamali","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhruv","family":"Singhal","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5533-3166","authenticated-orcid":false,"given":"Bernard T.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene Y.","family":"Fukudome","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.2106\/00004623-198567070-00013","article-title":"Non-union of fractures of the sternum","volume":"67","author":"II Mayba","year":"1985","journal-title":"J Bone Joint Surg Am"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/0003-4975(95)01035-1","article-title":"Postoperative mediastinitis: classification and management","volume":"61","author":"RM El Oakley","year":"1996","journal-title":"Ann Thorac Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.ejcts.2004.04.038","article-title":"Primary sternal plating in high-risk patients prevents mediastinitis","volume":"26","author":"DH Song","year":"2004","journal-title":"Eur J Cardiothorac Surg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-2002-26691","article-title":"Mediastinitis and cardiac surgery: an updated risk factor analysis in 10,373 consecutive adult patients","volume":"50","author":"JF Gummert","year":"2002","journal-title":"Thorac Cardiovasc Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/01.sap.0000139564.37314.1f","article-title":"Sternal nonunion: a review of current treatments and a new method of rigid fixation","volume":"54","author":"LC Wu","year":"2005","journal-title":"Ann Plast Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1016\/j.athoracsur.2012.07.085","article-title":"Sternal closure with rigid plate fixation versus wire closure: a randomized controlled multicenter trial","volume":"94","author":"J Raman","year":"2012","journal-title":"Ann Thorac Surg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1016\/S0003-4975(98)00231-8","article-title":"Biomechanical study of sternal closure using rigid fixation techniques in human cadavers","volume":"65","author":"W Ozaki","year":"1998","journal-title":"Ann Thorac Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.jtcvs.2016.10.093","article-title":"Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage","volume":"153","author":"KB Allen","year":"2017","journal-title":"J Thorac Cardiovasc 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infections: a systematic review","volume":"18","author":"H Cheng","year":"2017","journal-title":"Surg Infect (Larchmt)"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1097\/TA.0000000000000611","article-title":"Impact of specific postoperative complications on the outcomes of emergency general surgery patients","volume":"78","author":"CC McCoy","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/TA.0000000000000517","article-title":"The excess morbidity and mortality of emergency general surgery","volume":"78","author":"JM Havens","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.asjsur.2013.07.006","article-title":"Treatment of sternal wound infections after open-heart surgery","volume":"37","author":"YD Shi","year":"2014","journal-title":"Asian J Surg"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/PRS.0000000000003963","article-title":"Smoking as an independent risk factor for postoperative complications in plastic surgical procedures: a propensity score-matched analysis of 36,454 patients from the NSQIP database from 2005 to 2014","volume":"141","author":"Y Toyoda","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1177\/096721090301100306","article-title":"Risk factors influencing the outcome after surgical treatment of complicated deep sternal wound complications","volume":"11","author":"AA Peivandi","year":"2003","journal-title":"Cardiovasc Surg"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1093\/icvts\/ivt456","article-title":"Sternal replacement with a custom-made titanium plate after resection of a solitary breast cancer metastasis","volume":"18","author":"P Demondion","year":"2014","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1016\/j.athoracsur.2017.12.011","article-title":"Rigid plate fixation versus wire cerclage: patient-reported and economic outcomes from a randomized trial","volume":"105","author":"KB Allen","year":"2018","journal-title":"Ann Thorac Surg"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-aps.org\/upload\/pdf\/aps-2018-01102.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-aps.org\/journal\/view.php?doi=10.5999\/aps.2018.01102","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.5999\/aps.2018.01102.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T09:05:05Z","timestamp":1705568705000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.5999\/aps.2018.01102"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7]]},"references-count":22,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2022,3,28]]},"published-print":{"date-parts":[[2019,7]]}},"URL":"https:\/\/doi.org\/10.5999\/aps.2018.01102","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7]]},"assertion":[{"value":"2018-09-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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