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Abstract：
BACKGROUND: Negative pressure wound therapy (NPWT) is traditionally used to treat postoperative wound infections. However, its use in closed wound sternotomy post cardiac surgery in high-risk patients has become increasingly popular. The potential preventive benefit of reducing sternal wound infections has been recently acknowledged. Bilateral internal mammary artery (BIMA) grafts are used in coronary artery bypass grafting but have been associated with an increased risk of sternal wound infections (SWIs).
OBJECTIVE: This systematic analysis examines whether NPWT can reduce the incidence of SWI following BIMA grafts, leading to more patients benefiting from the better survival outcome associated with BIMA grafting.
METHODS: A comprehensive systematic search and meta-analysis were performed to identify studies on the use of NPWT in closed wound sternotomy. Ovid MEDLINE (in-process and other nonindexed citations and Ovid MEDLINE 1990 to present), Ovid EMBASE (1990 to present), and The Cochrane Library (Wiley), PubMed, and Google Scholar databases were searched from their inception to May 2022 using keywords and MeSH terms. Thirty-four articles from 1991 to May 2022 were selected.
RESULTS: Three studies reported on the outcome of NPWT following BIMA grafting. The pooled analysis did not show any significant difference in the incidence of sternal wound infection between NPWT and standard dressing (RR 0.48 95% CI 0.17-1.37; P = 0.17) with substantial heterogeneity (I2 65%). Another seven studies were found comparing the outcome of SWI incidence of negative pressure closed wound therapy with conventional wound therapy in patients undergoing adult cardiac surgery. The pooled analysis showed that NPWT was associated with a low risk of SWIs compared to conventional dressing (RR 0.47 95% CI 0.36-0.59; P < 0.00001), with low heterogeneity (I2 1%).
CONCLUSIONS: The literature identified that NPWT significantly decreased the incidence of sternal wound complications when applied to sutured sternotomy incisions in high-risk patients, and in some cases, it eliminated the risk. However, the inadequate number of randomized controlled trials assessing the effectiveness of NPWT in BIMA grafting emphasizes the need for further, robust studies.
OBJECTIVE: This systematic analysis examines whether NPWT can reduce the incidence of SWI following BIMA grafts, leading to more patients benefiting from the better survival outcome associated with BIMA grafting.
METHODS: A comprehensive systematic search and meta-analysis were performed to identify studies on the use of NPWT in closed wound sternotomy. Ovid MEDLINE (in-process and other nonindexed citations and Ovid MEDLINE 1990 to present), Ovid EMBASE (1990 to present), and The Cochrane Library (Wiley), PubMed, and Google Scholar databases were searched from their inception to May 2022 using keywords and MeSH terms. Thirty-four articles from 1991 to May 2022 were selected.
RESULTS: Three studies reported on the outcome of NPWT following BIMA grafting. The pooled analysis did not show any significant difference in the incidence of sternal wound infection between NPWT and standard dressing (RR 0.48 95% CI 0.17-1.37; P = 0.17) with substantial heterogeneity (I2 65%). Another seven studies were found comparing the outcome of SWI incidence of negative pressure closed wound therapy with conventional wound therapy in patients undergoing adult cardiac surgery. The pooled analysis showed that NPWT was associated with a low risk of SWIs compared to conventional dressing (RR 0.47 95% CI 0.36-0.59; P < 0.00001), with low heterogeneity (I2 1%).
CONCLUSIONS: The literature identified that NPWT significantly decreased the incidence of sternal wound complications when applied to sutured sternotomy incisions in high-risk patients, and in some cases, it eliminated the risk. However, the inadequate number of randomized controlled trials assessing the effectiveness of NPWT in BIMA grafting emphasizes the need for further, robust studies.
摘要：
背景：负压伤口疗法（NPWT）传统上用于治疗术后伤口感染。然而,它在高危患者心脏手术后闭合性胸骨切开术中的使用越来越受欢迎。最近已经认识到减少胸骨伤口感染的潜在预防益处。双侧乳内动脉（BIMA）移植物用于冠状动脉旁路移植术，但与胸骨伤口感染（SWI）的风险增加有关。
目的：这项系统分析检查了NPWT是否可以降低BIMA移植后SWI的发生率，导致更多的患者受益于BIMA移植相关的更好的生存结果。
方法：进行了全面的系统搜索和荟萃分析，以确定在闭合性胸骨切开术中使用NPWT的研究。OvidMEDLINE(过程中和其他非索引引文和OvidMEDLINE1990年至今)，OvidEMBASE(1990年至今)，科克伦图书馆（Wiley）PubMed,和GoogleScholar数据库从成立到2022年5月使用关键字和MeSH术语进行搜索。选择了1991年至2022年5月的34篇文章。
结果：三项研究报告了BIMA移植后NPWT的结果。汇总分析显示，NPWT和标准敷料之间的胸骨伤口感染发生率没有显着差异（RR0.4895％CI0.17-1.37；P=0.17），具有实质性异质性（I2.65％）。发现另外七项研究比较了成人心脏手术患者中负压封闭伤口治疗与常规伤口治疗的SWI发生率的结果。汇总分析表明，与常规敷料相比，NPWT与SWIs的低风险相关（RR0.4795％CI0.36-0.59；P<0.00001），具有低异质性（I2.1%）。
结论：文献表明，NPWT应用于高危患者的胸骨缝合切口时，可显著降低胸骨伤口并发症的发生率。在某些情况下,它消除了风险。然而,评估NPWT在BIMA嫁接中有效性的随机对照试验数量不足，强调需要进一步，健壮的研究。
目的：这项系统分析检查了NPWT是否可以降低BIMA移植后SWI的发生率，导致更多的患者受益于BIMA移植相关的更好的生存结果。
方法：进行了全面的系统搜索和荟萃分析，以确定在闭合性胸骨切开术中使用NPWT的研究。OvidMEDLINE(过程中和其他非索引引文和OvidMEDLINE1990年至今)，OvidEMBASE(1990年至今)，科克伦图书馆（Wiley）PubMed,和GoogleScholar数据库从成立到2022年5月使用关键字和MeSH术语进行搜索。选择了1991年至2022年5月的34篇文章。
结果：三项研究报告了BIMA移植后NPWT的结果。汇总分析显示，NPWT和标准敷料之间的胸骨伤口感染发生率没有显着差异（RR0.4895％CI0.17-1.37；P=0.17），具有实质性异质性（I2.65％）。发现另外七项研究比较了成人心脏手术患者中负压封闭伤口治疗与常规伤口治疗的SWI发生率的结果。汇总分析表明，与常规敷料相比，NPWT与SWIs的低风险相关（RR0.4795％CI0.36-0.59；P<0.00001），具有低异质性（I2.1%）。
结论：文献表明，NPWT应用于高危患者的胸骨缝合切口时，可显著降低胸骨伤口并发症的发生率。在某些情况下,它消除了风险。然而,评估NPWT在BIMA嫁接中有效性的随机对照试验数量不足，强调需要进一步，健壮的研究。
