Prevention of Sternal Wound Infections in Women Using an External Sternum Fixation Corset

Selten, Koen; Schnoering, Heike; Zayat, Rashad; Aljalloud, Ali; Moza, Ajay; Autschbach, Rüdiger; Tewarie, Lachmandath

doi:10.5761/atcs.oa.19-00293

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…A previous descriptive systematic review concluded that early post-sternotomy use of an external non-elastic sternal support device would reduce overall sternal wound complications and may reduce the hospital LOS [ 10 ]. In this context, observational series showed also similar findings as the current analysis [ 11 , 12 ].…”

Section: Discussionsupporting

confidence: 87%

Thorax support vest to prevent sternal wound infections in cardiac surgery patients—a systematic review and meta-analysis

Caldonazo,

Dell’Aquila,

Cancelli

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES Midline sternotomy is the main surgical access for cardiac surgeries. The most prominent complication of sternotomy is sternal wound infection (SWI). The use of a thorax support vest (TSV) that limits thorax movement and ensures sternal stability has been suggested to prevent postoperative SWI. We performed a meta-analysis to evaluate differences in clinical outcomes with and without the use of TSV after cardiac surgery in randomized trials. METHODS The primary outcome was deep SWI (DSWI). Secondary outcomes were superficial SWI (SSWI), sternal wound dehiscence, and hospital length of stay (LOS). A trial sequential analysis (TSA) was performed. Fixed (F) and random effects (R) model were calculated. RESULTS A total of 4 studies (3,820 patients) were included. Patients who wore the TSV had lower incidence of DSWI (OR= F : 0.24, 95% CI, 0.13–0.43, p < 0.01; R : 0.24, 0.04–1.59, p = 0.08), of sternal wound dehiscence (OR= F : 0.08, 95% CI, 0.02–0.27, p < 0.01; R : 0.10, 0.00–2.20, p = 0.08) and shorter hospital LOS (SMD= F:-0.30, -0.37 to -0.24, p < 0.01; R:-0.63, -1.29 to 0.02, p = 0.15). There was no difference regarding the incidence of SSWI (OR= F : 0.71, 95% CI, 0.34–1.47, p = 0.35; R : 0.64, 0.10, 4.26, p = 0.42). The TSA however showed that the observed decrease in DSWI in TSV arm cannot be considered conclusive based on the existing evidence. CONCLUSIONS This meta-analysis suggests that the use of a TSV after cardiac surgery could potentially be associated with a reduction in sternal wound complications. However, despite the significant treatment effect in the available studies, the evidence is not solid enough to provide strong practice recommendations.

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Section: Discussionsupporting

confidence: 87%

Thorax support vest to prevent sternal wound infections in cardiac surgery patients—a systematic review and meta-analysis

Caldonazo,

Dell’Aquila,

Cancelli

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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“…Sternal instability “per se” increases the risk of DSWI, whereby external stabilisation reduced the rate of DSWI in a large randomised trial regardless of conventional factors including age, female gender, DM, higher BMI, COPD, renal failure, the logistic EuroSCORE and non-elective indication for surgery [ 43 ]. A recent study in high-risk female patients undergoing cardiac surgery [ 44 ] demonstrated reduced DSWI when using a postoperative external stabilisation corset [ 45 ]. Conversely, intense coughing after surgery alone or in combination with, underestimated pleural effusions are factors promoting sternal instability [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Improved early risk stratification of deep sternal wound infection risk after coronary artery bypass grafting

Kamensek,

Kalisnik,

Ledwon

et al. 2024

J Cardiothorac Surg

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Background Deep sternal wound infection (DSWI) following open heart surgery is associated with excessive morbidity and mortality. Contemporary DSWI risk prediction models aim at identifying high-risk patients with varying complexity and performance characteristics. We aimed to optimize the DSWI risk factor set and to identify additional risk factors for early postoperative detection of patients prone to DSWI. Methods Single-centre retrospective analysis of patients with isolated multivessel coronary artery disease undergoing myocardial revascularization at Paracelsus Medical University Nuremberg between 2007 and 2022 was performed to identify risk factors for DSWI. Three data sets were created to examine preoperative, intraoperative, and early postoperative parameters, constituting the “Baseline”, the “Improved Baseline” and the “Extended” models. The “Extended” data set included risk factors that had not been analysed before. Univariable and stepwise forward multiple logistic regression analyses were performed for each respective set of variables. Results From 5221 patients, 179 (3.4%) developed DSWI. The “Extended” model performed best, with the area under the curve (AUC) of 0.80, 95%-CI: [0.76, 0.83]. Pleural effusion requiring intervention, postoperative delirium, preoperative hospital stay > 24 h, and the use of fibrin sealant were new independent predictors of DSWI in addition to age, Diabetes Mellitus on insulin, Body Mass Index, peripheral artery disease, mediastinal re-exploration, bilateral internal mammary harvesting, acute kidney injury and blood transfusions. Conclusions The “Extended” regression model with the short-term postoperative complications significantly improved DSWI risk discrimination after surgical revascularization. Short preoperative stay, prevention of postoperative delirium, protocols reducing the need for evacuation of effusion and restrictive use of fibrin sealant for sternal closure facilitate DSWI reduction. Trial registration The registered retrospective study was registered at the study centre and approved by the Institutional Review Board of Paracelsus Medical University Nuremberg (IRB-2019-005).

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“…Gender-related factors that simplify the bacterial penetration of the wound or reduce immune response are of interest in the current literature [16]. Sex-specific reports of outcomes after cardiac surgery have been controversially discussed [17,18].…”

Section: Discussionmentioning

confidence: 99%

Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery

Krasivskyi

Ivanov

Eghbalzadeh

et al. 2022

JCM

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Deep sternal wound infection (DSWI) is a feared complication after cardiac surgery. The impact of sex-related differences on wound infection prevalence is poorly understood. Our aim was to evaluate the effect of sex on short-term outcomes in patients with DSWI after open-heart surgery. The study was a retrospective cohort study. A total of 217 patients with DSWI were identified and retrospectively analyzed using our institutional database. Patients were divided into two groups: males (n = 150) and females (n = 67). This study also includes a propensity score based matching (PSM) analysis (male group (n = 62) and female group (n = 62)) to examine the unequal groups. Mean age (p = 0.088) and mean body mass index (BMI) (p = 0.905) did not significantly differ between both groups. Vacuum assisted closure (VAC) therapy was performed among most patients (82.3% (male group) vs. 83.9% (female group), p = 0.432). The most commonly isolated bacteria from the wounds were Staphylococcus epidermidis and Staphylococcus aureus in both groups. Acute renal failure was significantly higher (p = 0.010) in the male group compared to the female group. However, dialysis rate did not significantly differ (p = 0.491) between male and female groups. Further secondary outcomes showed no major differences between the groups. Likewise, in-hospital mortality rate did not differ significantly (p = 0.680) between both groups. Based on our data, sex has no impact on deep wound infection prevalence after cardiac surgery.

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Prevention of Sternal Wound Infections in Women Using an External Sternum Fixation Corset

Cited by 5 publications

References 29 publications

Thorax support vest to prevent sternal wound infections in cardiac surgery patients—a systematic review and meta-analysis

Thorax support vest to prevent sternal wound infections in cardiac surgery patients—a systematic review and meta-analysis

Improved early risk stratification of deep sternal wound infection risk after coronary artery bypass grafting

Sex-Associated Differences in Short-Term Outcomes in Patients with Deep Sternal Wound Infection after Open-Heart Surgery

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