Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections.
OBJECTIVE
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.
Department of Cardiothoracic Surgery,  Landspitali University Hospital, Reykjavik,  Iceland.
Steinn
S
Steingrimsson
Magnus
M
Gottfredsson
Ingibjorg
I
Gudmundsdottir
Johan
J
Sjögren
Tomas
T
Gudbjartsson
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003646:Debridement / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012086:Reoperation / Q000639:trends*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014945:Wound Healing