Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections
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 op...
Published in: | Interactive CardioVascular and Thoracic Surgery |
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European Association of Cardio-Thoracic Surgery
2012
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Online Access: | https://lup.lub.lu.se/record/3283985 https://doi.org/10.1093/icvts/ivs254 |
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ftulundlup:oai:lup.lub.lu.se:4b93daff-9db7-4e2b-9b54-528af2d4f61a 2023-05-15T16:52:40+02:00 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 Gudbjartsson, Tomas 2012 https://lup.lub.lu.se/record/3283985 https://doi.org/10.1093/icvts/ivs254 eng eng European Association of Cardio-Thoracic Surgery https://lup.lub.lu.se/record/3283985 http://dx.doi.org/10.1093/icvts/ivs254 wos:000310175900016 scopus:84869446820 pmid:22691377 Interactive Cardiovascular and Thoracic Surgery; 15(3), pp 406-410 (2012) ISSN: 1569-9285 Cardiac and Cardiovascular Systems Surgery Deep sternal wound infection (DSWI) Mediastinitis Cardiac surgery Negative-pressure wound therapy Outcome Re-infection contributiontojournal/article info:eu-repo/semantics/article text 2012 ftulundlup https://doi.org/10.1093/icvts/ivs254 2023-02-01T23:29:16Z 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. Article in Journal/Newspaper Iceland Lund University Publications (LUP) Interactive CardioVascular and Thoracic Surgery 15 3 406 410 |
institution |
Open Polar |
collection |
Lund University Publications (LUP) |
op_collection_id |
ftulundlup |
language |
English |
topic |
Cardiac and Cardiovascular Systems Surgery Deep sternal wound infection (DSWI) Mediastinitis Cardiac surgery Negative-pressure wound therapy Outcome Re-infection |
spellingShingle |
Cardiac and Cardiovascular Systems Surgery Deep sternal wound infection (DSWI) Mediastinitis Cardiac surgery Negative-pressure wound therapy Outcome Re-infection Steingrimsson, Steinn Gottfredsson, Magnus Gudmundsdottir, Ingibjorg Sjögren, Johan Gudbjartsson, Tomas Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections |
topic_facet |
Cardiac and Cardiovascular Systems Surgery Deep sternal wound infection (DSWI) Mediastinitis Cardiac surgery Negative-pressure wound therapy Outcome Re-infection |
description |
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. |
format |
Article in Journal/Newspaper |
author |
Steingrimsson, Steinn Gottfredsson, Magnus Gudmundsdottir, Ingibjorg Sjögren, Johan Gudbjartsson, Tomas |
author_facet |
Steingrimsson, Steinn Gottfredsson, Magnus Gudmundsdottir, Ingibjorg Sjögren, Johan Gudbjartsson, Tomas |
author_sort |
Steingrimsson, Steinn |
title |
Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections |
title_short |
Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections |
title_full |
Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections |
title_fullStr |
Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections |
title_full_unstemmed |
Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections |
title_sort |
negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections |
publisher |
European Association of Cardio-Thoracic Surgery |
publishDate |
2012 |
url |
https://lup.lub.lu.se/record/3283985 https://doi.org/10.1093/icvts/ivs254 |
genre |
Iceland |
genre_facet |
Iceland |
op_source |
Interactive Cardiovascular and Thoracic Surgery; 15(3), pp 406-410 (2012) ISSN: 1569-9285 |
op_relation |
https://lup.lub.lu.se/record/3283985 http://dx.doi.org/10.1093/icvts/ivs254 wos:000310175900016 scopus:84869446820 pmid:22691377 |
op_doi |
https://doi.org/10.1093/icvts/ivs254 |
container_title |
Interactive CardioVascular and Thoracic Surgery |
container_volume |
15 |
container_issue |
3 |
container_start_page |
406 |
op_container_end_page |
410 |
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1766043051772346368 |