Does Incisional Negative Pressure Wound Therapy Prevent Sternal Wound Infections?

Abstract

Background Incisional negative pressure wound therapy has been described as an effective method to prevent wound infections after open heart surgery in several publications. However, most studies have examined relatively small patient groups, only a few were randomized, and some have manufacturer-sponsorship. Most of the studies have utilized Prevena; there are only a few reports describing the PICO incisional negative pressure wound therapy system. Methods We conducted a prospective cohort study involving a propensity score-matched analysis to evaluate the effect of PICO incisional negative pressure wound therapy after coronary artery bypass grafting. A total of 180 high-risk patients with obesity or diabetes were included in the study group. The control group included 772 high-risk patients operated before the initiation of the study protocol. Results The rates of deep sternal wound infections in the PICO group and in the control group were 3.9 and 3.1%, respectively. The rates of superficial wound infections needing operative treatment were 3.1 and 0.8%, respectively. After propensity score matching with two groups of 174 patients, the incidence of both deep and superficial infections remained slightly elevated in the PICO group. None of the infections were due to technical difficulties or early interruption of the treatment. Conclusion It seems that incisional negative pressure wound therapy with PICO is not effective in preventing wound infections after coronary artery bypass grafting. The main difference in this study compared with previous reports is the relatively low incidence of infections in our control group.

Negative-Pressure Wound Therapy for Prevention of Sternal Wound Infection after Adult Cardiac Surgery: Systematic Review and Meta-Analysis

“…We speculate that the use of NPWT may be most effective for the prevention of deep SWI with a net benefit for the overall rates of any SWIs. This is confirmed by the results of most studies, with few exceptions [ 11 ]. A few recent studies [ 11 , 13 , 16 ] showed that there is a widespread use of this treatment, which suggest that clinicians are confident of a net benefit of NPWT, particularly in patients at highest risk of surgical site infection [ 11 , 13 ].…”

“…This is confirmed by the results of most studies, with few exceptions [ 11 ]. A few recent studies [ 11 , 13 , 16 ] showed that there is a widespread use of this treatment, which suggest that clinicians are confident of a net benefit of NPWT, particularly in patients at highest risk of surgical site infection [ 11 , 13 ]. Since the risk of SWI is particularly increased after bilateral internal mammary artery grafting [ 21 ], a benefit with the preventative use of NPWT may be more evident in such high-risk patients.…”

“…It is worth noting that the results of the study by Myllykangas et al [ 11 ] differ markedly from the overall risk of SWI herein estimated. The authors should be congratulated for having included in their analysis a large series of patients with rather well-balanced study cohorts after propensity score matching.…”

“…One hundred and ninety-one studies were retrieved from a systematic literature search ( Supplementary Materials Figure S1 ). Ten studies [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ] fulfilled the inclusion criteria. Their data are summarized in Table 2 and Supplementary Table S3 .…”

“…The results of the present pooled analysis could be summarized as follows: (1) there is evidence from recent studies of a widespread use of NPWT in adult cardiac surgery [ 11 , 13 , 16 ]; (2) the efficacy of NPWT in preventing post-sternotomy SWI has not been widely investigated; (3) NPWT may decrease the risk of SWI after adult cardiac surgery and its benefit may be more pronounced in preventing deep SWI; and (4) still, the evidence of a beneficial effect of NPWT in this patient population is based on studies with suboptimal quality.…”