Impact of vacuum-assisted closure therapy on outcomes of sternal wound dehiscence†.
OBJECTIVE
Sternal wound dehiscence (SWD) after cardiac surgery is a rare but serious condition associated with considerable costs and morbidity. We sought to evaluate the results of the introduction of vacuum-assisted closure (VAC) therapy in the management of sternal wound dehiscence, compared with those of previous conventional treatments.


METHODS
We retrospectively collected 7148 patients who underwent cardiac surgery at our institution between January 2002 and June 2012. A total of 152 (2.1%) patients had a sternal wound dehiscence: 107 were treated with conventional treatments (Group A) and 45 were managed with VAC therapy (Group B). Patients were stratified according to preoperative risk factors and type of sternal wound dehiscence (superficial or deep; infected or not) and compared by means of a propensity-matched analysis. A cost analysis was also performed.


RESULTS
Forty-five patients of each group matched for all preoperative risk factors and type of sternal wound dehiscence. SWD-related mortality rate was significantly lower in Group B (11 vs 0%; P = 0.05). Incidence of mediastinitis (P < 0.0001), sepsis (P = 0.04), delayed SWD infection (P = 0.05), other complication (P = 0.05), surgical sternal revision (P = 0.04) and surgical superficial revision (P < 0.0001) were all significantly lower in Group B. Mean patient cost was 31 106€ in Group A and 24 383€ in Group B, thus achieving a mean saving of 6723€ per patient.


CONCLUSIONS
In our experience, the use of VAC therapy for the management of SWD was considerably effective in decreasing mortality (SWD related), incidence of complications and need for surgical procedures; thus, leading to a significant reduction of costs.
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy v.tarzia@gmail.com.
Vincenzo
V
Tarzia
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Massimiliano
M
Carrozzini
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Giacomo
G
Bortolussi
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Edward
E
Buratto
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Jonida
J
Bejko
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Marina
M
Comisso
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Valentina
V
Mescola
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Valentina
V
Penzo
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Mauro
M
Guarino
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Marco
M
De Franceschi
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Chiara
C
Pagnin
Health Technology Assessment Unit, Padova University Hospital, Padova, Italy.
Massimo
M
Castoro
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Cosimo
C
Guglielmi
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Luca
L
Testolin
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Tomaso
T
Bottio
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
Gino
G
Gerosa
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008480:Mediastinitis / Q000382:microbiology / Q000628:therapy; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D057216:Propensity Score; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology / Q000628:therapy; D056346:Sternotomy / Q000009:adverse effects* / Q000191:economics / Q000401:mortality; D013529:Surgical Wound Dehiscence; D013530:Surgical Wound Infection / Q000382:microbiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
Cost analysis; Mediastinitis; Sternal wound complication; Sternal wound dehiscence; Surgical site infection; Vacuum-assisted closure therapy