Abstract
BackgroundSternal wound infection (SWI) following cardiothoracic surgery is a major complication. It may significantly impact patient recovery, treatment cost and mortality rates. No universal guideline exists on SWI management, and more recently the focus has become prevention over treatment. Recent studies report positive outcomes with closed incision negative pressure therapy (ciNPT) on surgical incisions, particularly for patients at risk of poor wound healing.ObjectiveThis study aims to assess the effect of ciNPT on SWI incidence in high-risk patients.MethodsA retrospective study was performed to investigate the benefit of ciNPT post sternotomy. Patients 3 years before the introduction of ciNPT (Control group) and 3 years after ciNPT availability (ciNPT group) were included. Only patients that had two or more of the risk factors; obesity, Chronic Obstructive Pulmonary Disease, old age and diabetes mellitus in the High Risk ciNPT cohort were given the ciNPT dressing. Patient demographics, EuroSCOREs and length of staywere reported as mean ± standard deviation. The Fisher’s exact test (two-tailed) and an unpaired t-test (two-tailed) were used to calculate the p-value for categorical data and continuous data, respectively.ResultsThe total number of patients was 1859 with 927 in the Control group and 932 in the ciNPT group. No statistical differences were noted between the groups apart from the Logistic EuroSCORE (Control = 6.802 ± 9.7 vs. ciNPT = 8.126 ± 11.3; P = 0.0002). The overall SWI incidence decreased from 8.7 to 4.4% in the overall groups with the introduction of ciNPT (P = 0.0005) demonstrating a 50% reduction. The patients with two and above risk factor in the Control Group (High Risk Control Group) were 162 while there was 158 in the ciNPT Group (High Risk ciNPT Group). The two groups were similar in all characteristics. Although the superficial and deep sternal would infections were higher in the High Risk Control Group versus the High Risk ciNPT group patients (20(12.4%) vs 9(5.6%); P = 0.049 respectively), the length of postoperative stay was similar in both (13.0 ± 15.1 versus 12.2 ± 15.6 days; p + 0.65). However the patients that developed infections in the two High Risk Groups stayed significantly longer than those who did not (25.5 ± 27.7 versus 12.2 ± 15.6 days;P = 0.008). There were 13 deaths in Hospital in the High Risk Control Group versus 10 in the High Risk ciNPT Group (P = 0.66).ConclusionIn this study, ciNPT reduced SWI incidence post sternotomy in patients at risk for developing SWI. This however did not translate into shorter hospital stay or mortality.
Highlights
Sternal wound infection (SWI) following cardiothoracic surgery is a major complication
This study aims to assess the effect of closed incision negative pressure therapy (ciNPT) use over a closed incision post-median sternotomy on the incidence of sternal wound infection (SWI) in high-risk patients with two or more risk factors with focus on the hypothesis that the use of ciNPT would reduce the rate of infection
We have demonstrated that the application of ciNPT to manage sternal incisions among patients with ≥2 risk factors may lower the incidence of SWIs with patients having longer postoperative stay if they develop an infection
Summary
Sternal wound infection (SWI) following cardiothoracic surgery is a major complication It may significantly impact patient recovery, treatment cost and mortality rates. Recent studies report positive outcomes with closed incision negative pressure therapy (ciNPT) on surgical incisions, for patients at risk of poor wound healing. We have reported previously a deep sternal wound infection (DSWI) incidence of 0.59% with an associated 1-year mortality rate of 9.1% with older age, obesity, diabetes and chronic obstructive pulmonary disease (COPD) as the associated risk factors in our department [4]. Recent studies have reported a reduced incidence of SWI complications in centres utilizing closed incision negative pressure therapy (ciNPT) [2]. Compared to a standard sterile dressing, the ciNPT canister can hold excess fluids removed from the incision It may be used over anatomically challenging incision locations whilst maintaining its seal, minimizing the risk from external contamination. The ciNPT unit is small so a patient can mobilise freely and the ciNPT dressing is waterproof allowing the patient to shower with the dressing in place [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
