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

Abstract

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.

Surgical site infection outcomes of two different closed incision negative pressure therapy systems in cardiac surgery: Systematic review and meta‐analysis

“…Use of ciNPT‐F was associated with reduced SSI compared to SOC dressings. Similarly, a previously published meta‐analysis on ciNPT use following cardiac surgery reported an association with a significantly lower risk of any sternal wound infection (SWI) and deep SWI with ciNPT use compared to SOC 31 . The recently published Tao et al meta‐analysis demonstrated a significant reduction in rates of both overall SSI and deep SSI in patients receiving ciNPT compared to patients receiving standard wound dressings 32 .…”

“…Similarly, a previously published meta-analysis on ciNPT use following cardiac surgery reported an association with a significantly lower risk of any sternal wound infection (SWI) and deep SWI with ciNPT use compared to SOC. 31 The recently published Tao et al meta-analysis demonstrated a significant [33][34][35][36][37][38][39][40][41][42][43] The Singh et al meta-analysis the use of ciNPT-F and ciNPT-MLA against SOC dressings to assess clinical outcomes after surgery, including a mix of surgical specialty types within the analysis. 33 Singh et al reported reduced rates of SSI following use of ciNPT-F compared to SOC dressings, while no differences were observed between ciNPT-MLA and SOC dressings.…”

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

“…Evidence from various studies suggests that the use of ciNPT in adult cardiac surgery is a valid adjunctive therapy where the maximum benefit seems to be in helping to mitigate the incidence of deep SWI cases post sternotomy [ 1 , 13 , 14 ]. SWI is a grave postoperative complication associated with cardiac surgery, and recent data have indicated a 30% mortality rate among high-risk populations, with recent data reporting 30% associated mortality among high-risk populations [ 2 ]. Willy et al noted obesity (BMI ≥ 30 kg/m 2 ), diabetes mellitus, respiratory insufficiency and tobacco use as risk factors for the development of SWI [ 15 ].…”

“…The development of a sternal wound infection (SWI) represents a major complication following cardiac surgery [ 1 ]. 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 ].…”

Negative Pressure Wound Therapy in Spinal Surgery

“…The use of NPWT is particularly relevant in cardiac surgery given the life-threatening consequences of a sternal SSI. A 2022 meta-analysis suggested that NPWT may prevent postoperative sternal SSI after cardiac surgery, although the quality of the evidence in the studies that were identified was fair and poor [ 21 ]. On the other hand, a 2013 randomized controlled trial of Prevena wound dressings vs. conventional wound dressings in obese patients undergoing cardiac surgery with closed incisions demonstrated a significantly reduced incidence of postoperative SSI in the Prevena group (OR 4.75, 95% CI 1.23–16.94) [ 22 ].…”