Incisional Negative Pressure Wound Therapy is Protective of Postoperative Cardiothoracic Wound Infection

Kaitlin A. Nguyen, BS, George A. Taylor, MD, Theresa K. Webster, BS, Rachel A. Jenkins, BS, Nicklaus S. Houston, BS, Dylan L. Kahler, MD, Andrew A. Gassman, MD, Christine M. Jones, MD

Department of Plastic and Reconstructive Surgery, Temple University, Philadelphia, PA, USA

 

BACKGROUND

Deep sternal wound infection (DSWI) is a rare but life-threatening

complication of cardiothoracic surgery, with most reported rates between

0.5-2%.

DSWI has a reported mortality rate as high as 30%, with an associated twofold

increase in cost of treatment.

While previously utilized only for the management of open wounds,

negative pressure therapy has been expanded to include application over

closed surgical incisions.

Closed incision negative pressure therapy (ciNPT) is applied

intraoperatively and provides continuous negative pressure at -125mmHg

for 5-7 days.

ciNPT has been associated with positive outcomes of decreased infection

rates and improved postoperative recovery.

 

OBJECTIVE

Determine whether ciNPT reduced wound infection and improved outcomes

in cardiothoracic surgery, in the largest population of this type studied to

date.

 

METHODS

A retrospective cohort study was performed including adult patients who

underwent nontraumatic cardiothoracic surgery at a single institution

between 2016-2018 (n=1199).

Subject characteristics were summarized by means and standard

deviations or frequencies and percentages, as applicable.

Significance was determined by independent samples t-tests and χ2 tests

(α = 0.05).

Analysis was completed using SPSS Statistics 26.

 

RESULTS

ciNPT was used in 58.9% of patients (n=706).

Patients who received ciNPT were older, with higher rates of

hyperlipidemia, MRSA colonization, statin use, and antihypertensive use.

Patients who did not receive ciNPT were more likely to have preoperative

steroid use and preoperative infections.

CABG and valve surgeries comprised a larger proportion of the ciNPT

group, while heart and lung transplants were more common in the control

group.

ciNPT was found to significantly reduce rates of both wound infection

(3.0% vs 6.3%, p = 0.01) and readmission for wound infection (0.7% vs

2.6%, p = 0.01).

ciNPT was found to be independently protective of surgical wound

infection (OR: 0.497, 95% CI: 0.262-0.945).

 

CONCLUSIONS

In the largest population studied to date, this study supported the expanded

use of ciNPT in cardiothoracic surgery to decrease postoperative wound

infection rates.