Resternotomy revisited

Since the publication of our UK national audit of resternotomy after cardiac surgery [1], we have performed additional analysis examining the variation in resternotomy across centres. Figure 1 shows a Forest plot of each centre and the number of resternotomies performed as a proportion of the total number of cases performed in the year. It can be seen that there are outliers in both directions; centres with higher than expected rates (centres 15 and 17) and centres with lower rates (centres 14, 22 and 24). There are numerous caveats to this analysis. Primarily these are uncontrolled data; we did not examine when resternotomy occurred, the pathways involved in each centre or when it occurred. However, the analysis does point to differences in practice that are affecting patient outcome. We intend to expand this work to examine why some centres have lower rates of resternotomy by collecting further data and liaisingwith the centres.