Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy.
J Hosp Infect. 2024 Jun;148:95-104. doi: 10.1016/j.jhin.2024.04.003. Epub 2024 Apr 26.
Surgical site infections (SSIs) pose a frequent complication in cardiac surgery patients and lead to increased patient discomfort and extended hospitalization. This meta-analysis aimed to evaluate the protective role of single-use negative-pressure wound therapy (sNPWT) devices on closed surgical wounds after cardiac surgery, and explored their potential preventive application across all cardiac surgery patients. A comprehensive literature search was conducted on ScienceDirect, focusing on studies related to "negative pressure wound therapy" or "PICO negative pressure wound therapy" combined with "cardiac surgery" or "sternotomy," published between 2000 and 2022. Inclusion criteria encompassed case-control studies comparing sNPWT with traditional dressings on closed cardiac surgical incisions in adult patients undergoing median sternotomy without immediate postoperative infective complications, with available details on SSIs. A retrospective analysis of cases treated with sNPWT in our centre was also performed. The meta-analysis revealed a protective role of sNPWT, indicating a 44% risk reduction in overall SSIs (odds ratio 0.56) and a 40% risk reduction in deep wound infections (odds ratio 0.60). Superficial wound infections, however, showed non-significant protective effects. A single-centre study aligned with the meta-analysis findings, confirming the efficacy of sNPWT and was included in the meta-analysis. In conclusion, the meta-analysis and the single-centre study collectively support the protective role of negative pressure wound therapy against overall and deep SSIs, suggesting its potential prophylactic use on all cardiac surgery populations.
手术后部位感染（SSI）是心脏手术患者常见的并发症，会增加患者的不适并延长住院时间。本荟萃分析旨在评估一次性使用负压伤口疗法（sNPWT）设备在心脏手术后闭合手术伤口中的保护作用，并探讨其在所有心脏手术患者中的潜在预防应用。在 ScienceDirect 上进行了全面的文献检索，重点关注 2000 年至 2022 年间与“负压伤口疗法”或“PICO 负压伤口疗法”结合“心脏手术”或“正中切开术”相关的研究。纳入标准包括比较经正中切开术的成年患者闭合性心脏外科切口的 sNPWT 与传统敷料的病例对照研究，且术后无即时感染并发症，并提供 SSI 的详细信息。还对我们中心接受 sNPWT 治疗的病例进行了回顾性分析。荟萃分析显示 sNPWT 具有保护作用，表明总体 SSI 的风险降低了 44%（优势比 0.56），深部伤口感染的风险降低了 40%（优势比 0.60）。然而，浅层伤口感染未显示出显著的保护作用。一项与荟萃分析结果一致的单中心研究也证实了 sNPWT 的疗效，并纳入了荟萃分析。总之，荟萃分析和单中心研究共同支持负压伤口疗法对总体和深部 SSI 的保护作用，表明其在所有心脏手术人群中具有潜在的预防应用。
