Format

Send to

Choose Destination
Interact Cardiovasc Thorac Surg. 2014 Jul;19(1):70-5. doi: 10.1093/icvts/ivu101. Epub 2014 Apr 9.

Impact of vacuum-assisted closure therapy on outcomes of sternal wound dehiscence†.

Author information

1
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy v.tarzia@gmail.com.
2
Department of Cardiac, Thoracic and Vascular Sciences, Cardiac Surgery Unit, University of Padova, Padova, Italy.
3
Health Technology Assessment Unit, Padova University Hospital, Padova, Italy.

Abstract

OBJECTIVES:

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.

KEYWORDS:

Cost analysis; Mediastinitis; Sternal wound complication; Sternal wound dehiscence; Surgical site infection; Vacuum-assisted closure therapy

PMID:
24722512
DOI:
10.1093/icvts/ivu101
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center