Does Elective Sternal Plating in Morbidly Obese Patients Reduce Sternal Complication Rates?

Background: Although the literature shows rigid plate fixation has superior outcomes over wire cerclage techniques, a patient population clearly benefitting from initial sternal plating over standard closure has not been identified. Data on plating as primary sternal closure in the morbidly obese patient remains sparse. Methods: A single-center retrospective study was performed on 564 consecutive patients undergoing complete median sternotomy from July 2014 to July 2017. Postoperative outcomes of patients with a body mass index of 35 kg/m² or more were compared between sternotomies with standard wire cerclage closure and those with sternal plate reinforcement. The primary endpoint was postoperative sternal complication defined as deep sternal wound infection, acute sternal dehiscence, chronic sternal disunion, or noninfectious sternal wound complication requiring operative intervention. Results: In all, 32.6% of sternotomies (184 of 564) were performed on patients with a body mass index of 35 kg/m² or greater. Of this group, 31.5% (58 of 184) underwent sternal closure with titanium plate reinforcement and 68.5% (126 of 184) underwent traditional chest closure. The overall sternal complication rate was 4.9% (9 of 184), consisting of 6 of 126 nonplated patients and 3 of 58 plated patients (4.8% vs 5.2%, P = .80). Conclusions: Sternal plate reinforcement for sternotomy closure of patients with a body mass index 35 kg/m² or greater produced no difference in postoperative sternal complication rates.