title: Primary closure using Redon drains vs vacuum-assisted closure in post-sternotomy mediastinitis.
abstract: OBJECTIVE
  Vacuum-assisted closure (VAC) is a commonly used therapy for the treatment of post-sternotomy mediastinitis. Primary closure of the sternum with high vacuum suction using Redon drains is an alternative that may reduce hospital stay. The aim of this study was to describe for the first time, the results of VAC compared with Redon drainage.
  
  
  METHODS
  We performed a retrospective analysis of 132 patients undergoing VAC (n = 89) or primary closure of the sternum with Redon drains (n = 43) as treatment for post-sternotomy mediastinitis between January 2000 and January 2011. Patient characteristics, risk factors and procedure-related variables were analysed. Duration of therapy, treatment failure, hospital stay and mortality as well as C-reactive protein and blood leucocyte counts on admission and at various time intervals during hospital stay were determined.
  
  
  RESULTS
  In-hospital mortality was 12.5% in the VAC group compared with 14% in the Redon group (P = 0.96). Treatment failure in the VAC and Redon groups occurred in 28 and 23% of the patients, respectively (P = 0.68). Intensive-care stay in the VAC group was 6.8 ± 14.4 days, and 4.8 ± 10.1 days in the Redon group (P = 0.99). Hospitalization in the VAC group was 74 ± 61 days and in the Redon group, 45 ± 38 days (P = 0.0001).
  
  
  CONCLUSIONS
  Primary closure using high vacuum suction drains is a safe and feasible treatment modality for post-sternotomy mediastinitis. It reduces hospital stay when compared with VAC therapy, without compromising mortality.
authors.affiliation: Department of Cardiothoracic Surgery,  St. Antonius Hospital, Nieuwegein,  Netherlands.
authors.forename: Roemer J
authors.initials: RJ
authors.lastname: Vos
authors.forename: Alaaddin
authors.initials: A
authors.lastname: Yilmaz
authors.forename: Uday
authors.initials: U
authors.lastname: Sonker
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: Geoffrey T L
authors.initials: GT
authors.lastname: Kloppenburg
mesh_terms: D000368:Aged; D057785:Catheters; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008480:Mediastinitis / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D057216:Propensity Score; D012189:Retrospective Studies; D056346:Sternotomy; D013396:Suction / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D013536:Suture Techniques; D016896:Treatment Outcome