Abstract：
BACKGROUND: Vacuum-assisted closure (VAC) therapy has become a popular treatment option for wound healing. The aim of this meta-analysis was to assess the use of VAC therapy as a bridge before the definitive treatment for the management of deep sternal wound complications.
METHODS: A systematic literature review and meta-analysis were performed in PubMed and Embase. Outcomes of interest included mortality, treatment failure, length of hospital stay (LOS), length of intensive care unit (ICU) stay and cost of treatment.
RESULTS: Twenty-two studies involving 1980 patients were included in the quantitative synthesis of this meta-analysis. Patients treated with VAC had significantly lower overall mortality [1738 patients; Risk ratio [RR] = 0.36 (95% confidence interval [CI]: 0.25, 0.51)], treatment failure [1210 patients; RR = 0.26 (95% CI: 0.19, 0.37)], LOS [498 patients; (standard mean difference = -0.44 (95% CI: -0.81, -0.07)] and ICU stay [309 patients; (standard mean difference = -0.34 (95% CI: -0.67, -0.01)] compared to that of non-VAC patients. VAC therapy was associated with reduced cost of treatment per patient compared with that of non-VAC therapies (reductions of 3600 USD, 6000 USD and 8983 USD in the reported studies).
CONCLUSIONS: VAC therapy as an adjunct in the definitive treatment of patients with deep sternal wound complications was associated with lower mortality, treatment failure, LOS, ICU stay and cost of treatment when compared with a non-VAC approach. Randomised controlled trials would be essential to confirm these findings.
METHODS: A systematic literature review and meta-analysis were performed in PubMed and Embase. Outcomes of interest included mortality, treatment failure, length of hospital stay (LOS), length of intensive care unit (ICU) stay and cost of treatment.
RESULTS: Twenty-two studies involving 1980 patients were included in the quantitative synthesis of this meta-analysis. Patients treated with VAC had significantly lower overall mortality [1738 patients; Risk ratio [RR] = 0.36 (95% confidence interval [CI]: 0.25, 0.51)], treatment failure [1210 patients; RR = 0.26 (95% CI: 0.19, 0.37)], LOS [498 patients; (standard mean difference = -0.44 (95% CI: -0.81, -0.07)] and ICU stay [309 patients; (standard mean difference = -0.34 (95% CI: -0.67, -0.01)] compared to that of non-VAC patients. VAC therapy was associated with reduced cost of treatment per patient compared with that of non-VAC therapies (reductions of 3600 USD, 6000 USD and 8983 USD in the reported studies).
CONCLUSIONS: VAC therapy as an adjunct in the definitive treatment of patients with deep sternal wound complications was associated with lower mortality, treatment failure, LOS, ICU stay and cost of treatment when compared with a non-VAC approach. Randomised controlled trials would be essential to confirm these findings.
摘要：
背景：真空辅助闭合（VAC）疗法已成为伤口愈合的流行治疗选择。这项荟萃分析的目的是评估在确定治疗深层胸骨伤口并发症之前使用VAC疗法作为桥梁。
方法：在PubMed和Embase进行了系统的文献综述和荟萃分析。感兴趣的结果包括死亡率，治疗失败,住院时间（LOS），重症监护病房（ICU）的住院时间和治疗费用。
结果：本荟萃分析的定量综合纳入了涉及1980例患者的22项研究。接受VAC治疗的患者总死亡率显著降低[1738例；风险比[RR]=0.36(95%置信区间[CI]:0.25,0.51)]。治疗失败[1210例；RR=0.26（95%CI：0.19，0.37）]，与非VAC患者相比，LOS[498例患者；（标准平均差=-0.44（95％CI：-0.81，-0.07）]和ICU住院时间[309例患者；（标准平均差=-0.34（95％CI：-0.67，-0.01）]。与非VAC疗法相比，VAC疗法与每位患者的治疗成本降低相关（减少3600美元，在报告的研究中，6000美元和8983美元)。
结论：VAC治疗作为胸骨深部伤口并发症患者的决定性治疗的辅助治疗与较低的死亡率相关。治疗失败,LOS,与非VAC方法相比，ICU住院时间和治疗费用。随机对照试验对于证实这些发现至关重要。
方法：在PubMed和Embase进行了系统的文献综述和荟萃分析。感兴趣的结果包括死亡率，治疗失败,住院时间（LOS），重症监护病房（ICU）的住院时间和治疗费用。
结果：本荟萃分析的定量综合纳入了涉及1980例患者的22项研究。接受VAC治疗的患者总死亡率显著降低[1738例；风险比[RR]=0.36(95%置信区间[CI]:0.25,0.51)]。治疗失败[1210例；RR=0.26（95%CI：0.19，0.37）]，与非VAC患者相比，LOS[498例患者；（标准平均差=-0.44（95％CI：-0.81，-0.07）]和ICU住院时间[309例患者；（标准平均差=-0.34（95％CI：-0.67，-0.01）]。与非VAC疗法相比，VAC疗法与每位患者的治疗成本降低相关（减少3600美元，在报告的研究中，6000美元和8983美元)。
结论：VAC治疗作为胸骨深部伤口并发症患者的决定性治疗的辅助治疗与较低的死亡率相关。治疗失败,LOS,与非VAC方法相比，ICU住院时间和治疗费用。随机对照试验对于证实这些发现至关重要。
