Department of Plastic Surgery, Kuopio University Hospital, Kuopio, Finland.
University of Eastern Finland School of Medicine, Kuopio, Pohjois-Savo, Finland.
Thorac Cardiovasc Surg. 2022 Jan;70(1):65-71. doi: 10.1055/s-0041-1731767. Epub 2021 Sep 14.
Incisional negative pressure wound therapy has been described as an effective method to prevent wound infections after open heart surgery in several publications. However, most studies have examined relatively small patient groups, only a few were randomized, and some have manufacturer-sponsorship. Most of the studies have utilized Prevena; there are only a few reports describing the PICO incisional negative pressure wound therapy system.
We conducted a prospective cohort study involving a propensity score-matched analysis to evaluate the effect of PICO incisional negative pressure wound therapy after coronary artery bypass grafting. A total of 180 high-risk patients with obesity or diabetes were included in the study group. The control group included 772 high-risk patients operated before the initiation of the study protocol.
The rates of deep sternal wound infections in the PICO group and in the control group were 3.9 and 3.1%, respectively. The rates of superficial wound infections needing operative treatment were 3.1 and 0.8%, respectively. After propensity score matching with two groups of 174 patients, the incidence of both deep and superficial infections remained slightly elevated in the PICO group. None of the infections were due to technical difficulties or early interruption of the treatment.
It seems that incisional negative pressure wound therapy with PICO is not effective in preventing wound infections after coronary artery bypass grafting. The main difference in this study compared with previous reports is the relatively low incidence of infections in our control group.
有几项出版物描述了切口负压伤口治疗是一种预防心脏直视手术后伤口感染的有效方法。然而，大多数研究都检查了相对较小的患者群体，只有少数是随机的，并且有些是制造商赞助的。大多数研究都使用了 Prevena；只有少数报道描述了 PICO 切口负压伤口治疗系统。
我们进行了一项前瞻性队列研究，包括倾向评分匹配分析，以评估冠状动脉旁路移植术后使用 PICO 切口负压伤口治疗的效果。共有 180 名肥胖或糖尿病的高危患者被纳入研究组。对照组包括在研究方案启动前接受手术的 772 名高危患者。
PICO 组和对照组的深部胸骨伤口感染率分别为 3.9%和 3.1%。需要手术治疗的浅表伤口感染率分别为 3.1%和 0.8%。在对两组各 174 名患者进行倾向评分匹配后，PICO 组深部和浅表感染的发生率仍略有升高。没有一例感染是由于技术困难或治疗早期中断引起的。
似乎 PICO 切口负压伤口治疗在预防冠状动脉旁路移植术后伤口感染方面并不有效。与以往报告相比，本研究的主要区别在于我们对照组的感染发生率相对较低。
