Advanced

Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections

Steingrimsson, Steinn; Gottfredsson, Magnus; Gudmundsdottir, Ingibjorg; Sjögren, Johan LU and Gudbjartsson, Tomas (2012) In Interactive Cardiovascular and Thoracic Surgery 15(3). p.406-410
Abstract
OBJECTIVES: To evaluate the outcome of treatment for deep sternal wound infection (DSWI) in a nationwide patient cohort, before and after the introduction of negative-pressure wound therapy (NPWT). METHODS: This was a population-based cohort of all patients treated for DSWI in Iceland out of 2446 open heart operations performed between 2000 and 2010. Length of hospital stay, survival and reoperations were compared in (i) 23 patients treated with open and/or closed irrigation before August 2005 (conventional treatment, CvT group) and in (ii) 20 patients treated after this time with NPWT as a first-line therapy (NPWT group). RESULTS: The DSWI rate was 1.8% and did not change during the study period. Demographics were similar for both groups,... (More)
OBJECTIVES: To evaluate the outcome of treatment for deep sternal wound infection (DSWI) in a nationwide patient cohort, before and after the introduction of negative-pressure wound therapy (NPWT). METHODS: This was a population-based cohort of all patients treated for DSWI in Iceland out of 2446 open heart operations performed between 2000 and 2010. Length of hospital stay, survival and reoperations were compared in (i) 23 patients treated with open and/or closed irrigation before August 2005 (conventional treatment, CvT group) and in (ii) 20 patients treated after this time with NPWT as a first-line therapy (NPWT group). RESULTS: The DSWI rate was 1.8% and did not change during the study period. Demographics were similar for both groups, except for peripheral arterial disease which was less common in the NPWT group. Coagulase-negative staphylococci were also more common (as the only pathogen identified) in the NPWT group (70% vs 30%, P = 0.01). The median length of hospital stay was 43 days in both groups and the sternum could be closed with delayed primary closure in all except 2 patients, one in each group. Eight patients in the CvT group required surgical revision for re-infections, including debridement and rewiring, when compared with 1 patient in the NPWT group (P = 0.02). Furthermore, 6 patients in the CvT group developed late chronic infections of the sternum requiring surgical revision, compared with one in the NPWT group (P = 0.10). The 30-day mortality was not significantly different between groups (4% vs 0%, P > 0.1) and the same was true for 1-year mortality (17% vs 0%, P = 0.11). CONCLUSIONS: NPWT significantly reduces the risk of early re-infections in patients with DSWI. There was a lower rate of late chronic sternal infections and lower mortality in the NPWT group, but the difference was not statistically significant. We conclude that NPWT should be considered as a first-line treatment for most DSWIs. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Deep sternal wound infection (DSWI), Mediastinitis, Cardiac surgery, Negative-pressure wound therapy, Outcome, Re-infection
in
Interactive Cardiovascular and Thoracic Surgery
volume
15
issue
3
pages
406 - 410
publisher
European Association of Cardio-Thoracic Surgery
external identifiers
  • wos:000310175900016
  • scopus:84869446820
ISSN
1569-9285
DOI
10.1093/icvts/ivs254
language
English
LU publication?
yes
id
4b93daff-9db7-4e2b-9b54-528af2d4f61a (old id 3283985)
date added to LUP
2013-01-07 09:42:46
date last changed
2017-07-23 03:20:45
@article{4b93daff-9db7-4e2b-9b54-528af2d4f61a,
  abstract     = {OBJECTIVES: To evaluate the outcome of treatment for deep sternal wound infection (DSWI) in a nationwide patient cohort, before and after the introduction of negative-pressure wound therapy (NPWT). METHODS: This was a population-based cohort of all patients treated for DSWI in Iceland out of 2446 open heart operations performed between 2000 and 2010. Length of hospital stay, survival and reoperations were compared in (i) 23 patients treated with open and/or closed irrigation before August 2005 (conventional treatment, CvT group) and in (ii) 20 patients treated after this time with NPWT as a first-line therapy (NPWT group). RESULTS: The DSWI rate was 1.8% and did not change during the study period. Demographics were similar for both groups, except for peripheral arterial disease which was less common in the NPWT group. Coagulase-negative staphylococci were also more common (as the only pathogen identified) in the NPWT group (70% vs 30%, P = 0.01). The median length of hospital stay was 43 days in both groups and the sternum could be closed with delayed primary closure in all except 2 patients, one in each group. Eight patients in the CvT group required surgical revision for re-infections, including debridement and rewiring, when compared with 1 patient in the NPWT group (P = 0.02). Furthermore, 6 patients in the CvT group developed late chronic infections of the sternum requiring surgical revision, compared with one in the NPWT group (P = 0.10). The 30-day mortality was not significantly different between groups (4% vs 0%, P > 0.1) and the same was true for 1-year mortality (17% vs 0%, P = 0.11). CONCLUSIONS: NPWT significantly reduces the risk of early re-infections in patients with DSWI. There was a lower rate of late chronic sternal infections and lower mortality in the NPWT group, but the difference was not statistically significant. We conclude that NPWT should be considered as a first-line treatment for most DSWIs.},
  author       = {Steingrimsson, Steinn and Gottfredsson, Magnus and Gudmundsdottir, Ingibjorg and Sjögren, Johan and Gudbjartsson, Tomas},
  issn         = {1569-9285},
  keyword      = {Deep sternal wound infection (DSWI),Mediastinitis,Cardiac surgery,Negative-pressure wound therapy,Outcome,Re-infection},
  language     = {eng},
  number       = {3},
  pages        = {406--410},
  publisher    = {European Association of Cardio-Thoracic Surgery},
  series       = {Interactive Cardiovascular and Thoracic Surgery},
  title        = {Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections},
  url          = {http://dx.doi.org/10.1093/icvts/ivs254},
  volume       = {15},
  year         = {2012},
}