Prophylactic Negative Pressure Wound Dressing Does Not Reduce the Incidence of Sternal Wound Infection After Coronary Artery Bypass Grafting: A Propensity-Matched Analysis
Elsayed Elmistekawy, Thin Xuan Vo, Sophia Chaudry, Louise Sun Sun, Buu-Khanh Lam.
Ottawa Heart Institute, Ottawa, ON, Canada.
OBJECTIVE: Sternal wound infection (SWI) is a devastating complication after CABG surgery. Negative pressure wound therapy (NPWT) have become an integral modality for management of SWI. We explored the routine use of NPWT as a prophylactic measure to reduce sternal wound infection after CABG.
METHODS: After ethics board approval, 38 patients scheduled for CABG surgery with at least two known risk factors for SWI underwent NPWTwound dressing with the PICO Single Use System the OR and for 5 days after surgery. The perioperative and outcome data for this patient cohort was prospectively collected and compared to the data for all patients who underwent CABG surgery during the same period of time. A propensity matching analysis was performed for 31 patients who received a sternal wound dressing with the PICO system, compared with 31 patients who only received standard sternal wound dressing.
RESULTS: Prior to propensity matching, the PICO patient cohort were older (p value = 0.019), more obese (p value = 0.0009) and were more commonly hypertensive (p value = 0.0011). After propensity matching both groups were similar in perioperative characteristics. Five patients in each group sustained a SWI. Multivariable analysis found that older age, diabetes mellitus, obesity and blood transfusion are predictors of SWI in this cohorts. There was no significant difference between incidence of SWI between the 2 groups (p value = 0.1128).
CONCLUSIONS: The prophylactic use of NPWT using the PICO system was not associated with reduction in the risk of SWI after CABG.
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