Risk Factors for Sternal Complications After Cardiac Operations: A Systematic Review Sulakshana Balachandran, PhD, Annemarie Lee, PhD, Linda Denehy, PhD,

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Risk Factors for Sternal Complications After Cardiac Operations: A Systematic Review Sulakshana Balachandran, PhD, Annemarie Lee, PhD, Linda Denehy, PhD, Kuan-Yin Lin, MS, Alistair Royse, MBBS, MD, Colin Royse, MBBS, MD, Doa El-Ansary, PhD The Annals of Thoracic Surgery Volume 102, Issue 6, Pages 2109-2117 (December 2016) DOI: 10.1016/j.athoracsur.2016.05.047 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart outlining the selection of studies included in the systematic review and meta-analysis. The Annals of Thoracic Surgery 2016 102, 2109-2117DOI: (10.1016/j.athoracsur.2016.05.047) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Meta-analyses for identified preoperative risk factors for sternal infection: (a) female gender, (b) active smoking, (c) diabetes mellitus, and (d) obesity. The solid vertical line indicates no effect. The solid squares indicate the mean difference and are proportional to the weights used in the meta-analysis. The diamond indicates the weighted mean difference, and the lateral tips of the diamond indicate the associated confidence intervals (CI). The horizontal lines represent the 95% CI. (M-H = Mantel-Haenszel test.) The Annals of Thoracic Surgery 2016 102, 2109-2117DOI: (10.1016/j.athoracsur.2016.05.047) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Meta-analysis for identified perioperative risk factor for sternal infection: bilateral internal mammary artery grafts. The solid vertical line indicates no effect. The solid squares indicate the mean difference and are proportional to the weights used in the meta-analysis. The diamond indicates the weighted mean difference, and the lateral tips of the diamond indicate the associated confidence intervals (CI). The horizontal lines represent the 95% CI. (M-H = Mantel-Haenszel test.) The Annals of Thoracic Surgery 2016 102, 2109-2117DOI: (10.1016/j.athoracsur.2016.05.047) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Meta-analyses for identified postoperative risk factors for sternal infection: (a) reoperation for postoperative complications and (b) blood product requirement. The solid vertical line indicates no effect. The solid squares indicate the mean difference and are proportional to the weights used in the meta-analysis. The diamond indicates the weighted mean difference, and the lateral tips of the diamond indicate the associated confidence intervals (CI). The horizontal lines represent the 95% CI. (M-H = Mantel-Haenszel test.) The Annals of Thoracic Surgery 2016 102, 2109-2117DOI: (10.1016/j.athoracsur.2016.05.047) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions