Use of a negative pressure wound therapy system over closed incisions option in preventing post‐sternotomy wound complications

Brega, Carlotta; Calvi, Simone; Albertini, Alberto

doi:10.1111/wrr.12914

Cited by 6 publications

(10 citation statements)

References 17 publications

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“…Aside from potential life-threatening consequences, SWI is associated with a prolonged length of stay (LOS) in the hospital and, according to the European Health Service, may add an estimated 19 billion Euros of additional health care costs [ 2 ]. It has been previously demonstrated that avoiding virulent bacterial contamination that can lead to mediastinitis and the degradation of sutured skin, especially in high-risk patients, is integral to helping prevent postoperative complications associated with SWI [ 3 , 4 ]. This postoperative complication is most prevalent in patients with a medical history of obesity, diabetes, chronic obstructive pulmonary disease (COPD) and advanced age [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Closed-incision negative pressure therapy as a strategy to reduce sternal wound infection in identified high-risk patients: a multicentre propensity matched study

Suelo-Calanao,

D’Alessio,

Hutton

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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Objective The premise of this retrospective study was to evaluate the intraoperative use of closed incision negative pressure therapy (ciNPT) to help reduce the incidence of postoperative sternal wound infections (SWI) in multimorbid patients with an elevated risk of developing an SWI post cardiac surgery versus a cohort that received standard of care dressings. Methods Data of all adult patients were collected from each cardiothoracic surgery units across three hospitals in the United Kingdom. High-risk patients had two or more recognised risk factors. Fisher’s exact test (two-tailed) and unpaired t-test helped analyse categorical and continuous data. Propensity matching was performed to compare the two groups. Results A total of 5,288 patients who had cardiac surgery were included. Propensity matching led to 766 matched cases. There were significantly fewer sternal wound infections in the ciNPT group (43 [5.6%] versus 119 [15.5%] cases; p = 0.0001), as well as fewer deep sternal wound infections (14 [1.8%] versus 31 [4.0%] cases; p = 0.0149) and superficial sternal wound infections (29 [3.8%] versus 88 [11.4%] cases; p = 0.0001). A higher mean length of stay in the ciNPT group was statistically significant (11.23±13 versus 9.66±10 days; p = 0.0083) as well as a significantly higher mean logistic EuroSCORE (11.143±13 versus 8.094±11; p = 0.0001). A statistically significant higher readmission to intensive care due to sternal wound infection was noted for the Control (16 [2.08%] versus 3 [0.39%] readmissions; p = 0.0042). Conclusion ciNPT appears to be an effective intervention to help reduce the incidence of sternal wound infection in high-risk individuals undergoing cardiac surgery.

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Section: Introductionmentioning

confidence: 99%

Closed-incision negative pressure therapy as a strategy to reduce sternal wound infection in identified high-risk patients: a multicentre propensity matched study

Suelo-Calanao,

D’Alessio,

Hutton

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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“…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 .…”

Section: Resultsmentioning

confidence: 99%

“… Forest plots of study interventions and outcomes [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. …”

Section: Figurementioning

confidence: 99%

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

Biancari

Santoro²,

Provenzano³

et al. 2022

JCM

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The results of current studies are not conclusive on the efficacy of incisional negative-pressure wound therapy (NPWT) for the prevention of sternal wound infection (SWI) after adult cardiac surgery. A systematic review of the literature was performed through PubMed, Scopus and Google to identify studies which investigated the efficacy of NPWT to prevent SWI after adult cardiac surgery. Available data were pooled using RevMan and Meta-analyst with random effect models. Out of 191 studies retrieved from the literature, ten fulfilled the inclusion criteria and were included in this analysis. The quality of these studies was judged fair for three of them and poor for seven studies. Only one study was powered to address the efficacy of NPWT for the prevention of postoperative SWI. Pooled analysis of these studies showed that NPWT was associated with lower risk of any SWI (4.5% vs. 9.0%, RR 0.54, 95% CI 0.34–0.84, I2 48%), superficial SWI (3.8% vs. 4.4%, RR 0.63, 95% CI 0.29–1.36, I2 65%), and deep SWI (1.8% vs. 4.7%, RR 0.46, 95% CI 0.26–0.74, I2 0%), but such a difference was not statistically significant for superficial SWI. When only randomized and alternating allocated studies were included, NPWT was associated with a significantly lower risk of any SWI (3.3% vs. 16.5%, RR 0.22, 95% CI 0.08–0.62, I2 0%), superficial SWI (2.6% vs. 12.4%, RR 0.21, 95% CI 0.06–0.69, I2 0%), and deep SWI (1.2% vs. 4.8%, RR 0.17, 95% CI 0.03–0.95, I2 0%). This pooled analysis showed that NPWT may prevent postoperative SWI after adult cardiac surgery. NPWT is expected to be particularly useful in patients at risk for surgical site infection and may significantly reduce the burden of resources needed to treat such a complication. However, the methodology of the available studies was judged as poor for most of them. Further studies are needed to obtain conclusive results on the potential benefits of this preventative strategy.

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“…Brega et al [ 23 ] analyzed 90 patients undergoing cardiac surgery with a median sternal incision and found that, compared with conventional gauze, hydrocolloids, and carboxymethyl fibrin dressings, the patients who underwent NPWT at closed incisions had a significantly lower incidence of deep sternal complications than those who were administered conventional gauze, hydrocolloids, and carboxymethyl fibrin dressings. [ 23 ] The difference was obvious in patients with obesity. In a retrospective study, Bonds et al [ 24 ] analyzed 254 patients undergoing colorectal surgery and found that 69 (27.2%) developed SSIs, of which 4 (12.5%) occurred in patients receiving incision negative pressure therapy and 65 (29.3%) occurred in patients receiving a standard suture.…”

Section: Discussionmentioning

confidence: 99%

“…[22] Several experiments have been carried out on the treatment of surgical incision and the reduction of infection and other complications with NWPT. Brega et al [23] analyzed 90 patients undergoing cardiac surgery with a median sternal incision and found that, compared with conventional gauze, hydrocolloids, and carboxymethyl fibrin dressings, the patients who underwent NPWT at closed incisions had a significantly lower incidence of deep sternal complications than those who were administered conventional gauze, hydrocolloids, and carboxymethyl fibrin dressings. [23] The difference was obvious in patients with obesity.…”

Section: Discussionmentioning

confidence: 99%

Negative pressure wound therapy reduces the incidence of postoperative wound dehiscence and surgical site infections after total knee arthroplasty in patients with obesity

et al. 2022

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Obesity is a risk factor for total knee arthroplasty (TKA). Wound dehiscence and surgical site infections (SSIs) are the main complications of TKA in patients with obesity. They can profoundly affect patients because they often require readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue. This study aims to assess the incidence of wound dehiscence and SSIs in patients with obesity undergoing TKA after the routine use of NPWT. This sduty enrolled adult patients with obesity who underwent TKA within 8 years. A total of 360 adult patients with obesity (NPWT: 150, non-NPWT: 210) underwent TKA, and the baseline characteristics were similar between the 2 groups. Compared with the non-NPWT group, the NPWT group had a 50% lower incidence of wound dehiscence (3.33% vs 9.52%; P < .05) and a significantly lower incidence of SSIs (11.33% vs 25.24%; P < .05), including prosthetic joint infection (4.0% vs 10.0%; P < .05) and superficial wound infection (7.33% vs 15.24%; P < .05). In addition, the NPWT group had a lower need to return to the operating room for new interventions for any reason (2.67% vs 9.05%; P = .0107) than the non-NPWT group. Conventional incision NPWT can significantly reduce the incidence of wound dehiscence and SSIs in patients with obesity after TKA.

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Use of a negative pressure wound therapy system over closed incisions option in preventing post‐sternotomy wound complications

Cited by 6 publications

References 17 publications

Closed-incision negative pressure therapy as a strategy to reduce sternal wound infection in identified high-risk patients: a multicentre propensity matched study

Closed-incision negative pressure therapy as a strategy to reduce sternal wound infection in identified high-risk patients: a multicentre propensity matched study

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

Negative pressure wound therapy reduces the incidence of postoperative wound dehiscence and surgical site infections after total knee arthroplasty in patients with obesity

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