Biancari Fausto, Santoro Grazia, Provenzano Federica, Savarese Leonardo, Iorio Francesco, Giordano Salvatore, Zebele Carlo, Speziale Giuseppe
Clinica Montevergine, GVM Care & Research, 83013 Mercogliano, Italy.
Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland.
J Clin Med. 2022 Jul 22;11(15):4268. doi: 10.3390/jcm11154268.
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, I 48%), superficial SWI (3.8% vs. 4.4%, RR 0.63, 95% CI 0.29-1.36, I 65%), and deep SWI (1.8% vs. 4.7%, RR 0.46, 95% CI 0.26-0.74, I 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, I 0%), superficial SWI (2.6% vs. 12.4%, RR 0.21, 95% CI 0.06-0.69, I 0%), and deep SWI (1.2% vs. 4.8%, RR 0.17, 95% CI 0.03-0.95, I 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.
目前的研究结果对于切开负压伤口治疗（NPWT）预防成人心脏手术后胸骨伤口感染（SWI）的疗效尚无定论。通过PubMed、Scopus和谷歌对文献进行系统回顾，以确定研究NPWT预防成人心脏手术后SWI疗效的研究。使用RevMan和Meta-analyst软件，采用随机效应模型对现有数据进行汇总。从文献中检索出的191项研究中，有10项符合纳入标准并纳入本分析。其中3项研究质量被判定为中等，7项研究质量较差。只有1项研究有足够的样本量来探讨NPWT预防术后SWI的疗效。对这些研究的汇总分析表明，NPWT与任何SWI的较低风险相关（4.5%对9.0%，RR 0.54，95%CI 0.34 - 0.84，I² 48%）、浅表SWI（3.8%对4.4%，RR 0.63，95%CI 0.29 - 1.36，I² 65%）和深部SWI（1.8%对4.7%，RR 0.46，95%CI 0.26 - 0.74，I² 0%），但对于浅表SWI，这种差异无统计学意义。当仅纳入随机和交替分配的研究时，NPWT与任何SWI的显著较低风险相关（3.3%对16.5%，RR 0.22，95%CI 0.08 - 0.62，I² 0%）、浅表SWI（2.6%对12.4%，RR 0.21，95%CI 0.06 - 0.69，I² 0%）和深部SWI（1.2%对4.8%，RR 0.17，95%CI 0.03 - 0.95，I² 0%）。该汇总分析表明，NPWT可能预防成人心脏手术后的术后SWI。NPWT预计在手术部位感染风险较高的患者中特别有用，并且可能显著减轻治疗这种并发症所需的资源负担。然而，现有研究的方法学在大多数研究中被判定为较差。需要进一步研究以获得关于这种预防策略潜在益处的确切结果。
