Prophylactic Application of Closed Incision Negative Pressure Therapy After High Risk Cardiothoracic Procedures: A Single Center Study

Year 2024, Volume: 77 Issue: 2, 169 - 173, 12.08.2024

Nur Dikmen , Evren Özçınar , Zeynep Eyileten Ahmet Rüçhan Akar

Abstract

Objectives: Sternal wound infections (SWIs) after cardiac surgery are devastating complications and cost loads for healthcare providers and
vulnerable patients in the postoperative period after high-risk cardiothoracic operations. Although the prophylactic use of closed incision negative
pressure therapy (ciNPT) is still controversial, recent studies report positive outcomes. Our study aims to identify the efficacy of ciNPT in ventricular
assist device implantation procedures with focus on the hypothesis that the reduction rate of impaired healing and infection.

Materials and Methods: We performed a retrospective study with 18 advanced heart failure patients after ventricular assist devices implantations.
Conventional sterile gauze dressings were applied in the control group (n=10), while ciNPT (Prevena™ system) was applied in the study group.
Patients demographics, risk factors such as diabetes mellitus, obesity, smoking, chronic obstructive pulmonary disease, Euroscore II and Fowler Risk
score were documented. Wounds were examined instantly after removal of Prevena™ system on postoperative 6 to 8 days and on follow-up 45 days.
Signs of infections and healing problems, inflammatory biomarkers were noted.

Results: The number of ventricular assist device implantations were 18, with 10 in control and 8 in study group. Both groups were similar in all
demographical characteristics. Driveline insertion site and superficial SWI rates were higher in control group than the study group (p=0.003 and
p=0.018, respectively). One superficial SWI was noted in the control group. No deep wound infections requiring debridement was observed in both
groups. Length of hospital stay was longer in control group (p=0.05).

Conclusion: We concluded that closed incision ciNPT has an impact on reducing driveline site infections, length of hospitalization and cost load for
health care providers. This preliminary results appear to support the advantage of closed incision ciNPT application after ventricular assist device
implantation procedures and serve as a basic information for more comprehensive studies.

Keywords

Closed incisional negative pressure therapy , sternal driveline site infections , wound infections , wound therapy

Ethical Statement

This retrospective study was approved by the Ankara University, Human Research Ethics Committee (approval no.: İ02-156-24, date: 06.03.2024).

Supporting Institution

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Project Number

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Thanks

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Yüksek Riskli Kardiyotorasik Cerrahi İşlemler Sonrası Kapalı İnsizyon Negatif Basınç Tedavisinin Profilaktik Uygulaması: Tek Merkezli Çalışma

Abstract

Amaç: Kalp cerrahisi sonrası sternal yara enfeksiyonları, özellikle yüksek riskli kardiyotorasik operasyonlardan sonraki postoperatif dönemde
hastalar ve sağlık hizmeti sunucuları için önemli komplikasyonlara ve maliyet yüklerine neden olmaktadır. Profilaktik kapalı insizyon negatif basınç
tedavisinin kullanımı halen tartışmalı olsa da, son yıllarda yapılan çalışmalarda olumlu sonuçlar bildirilmektedir. Çalışmamız, ventriküler destek
sistemi implantasyonu prosedürleri sonrası kapalı insizyon negatif basınç tedavisinin etkinliğini, iyileşme sorunlarında ve enfeksiyon oranlarında
azalma hipotezine odaklanarak sunmayı amaçlamaktadır.

Gereç ve Yöntem: Çalışmamız, ileri evre kalp yetmezliği olan ve ventriküler destek cihazı implantasyonu yapılan 18 hastanın takip verilerine
retrospektif olarak ulaşılarak gerçekleştirilmiştir. Kontrol grubuna (n=10) geleneksel steril gazlı bez pansumanları uygulanırken, çalışma grubuna
kapalı insizyon negatif basınç tedavisi (Prevena™ sistemi) uygulanmıştır. Hastaların demografik özellikleri, diabetes mellitus, obezite, sigara
kullanımı, kronik obstrüktif akciğer hastalığı gibi risk faktörleri, Euroscore II ve Fowler risk skorları kaydedilmiştir. İnsizyonlar, Prevena™ sistemininçıkarılmasından hemen sonra postoperatif 6 ila 8. günlerde ve 45. günde değerlendirilmiştir. Enfeksiyon belirtileri ve iyileşme sorunları,
enflamatuvar biyobelirteçler kaydedilmiştir.

Bulgular: Ventriküler destek cihazı implantasyonu yapılan hasta sayısı 10’u kontrol, 8’i çalışma grubunda olmak üzere 18 idi. Her iki grup da tüm
demografik özellikler açısından benzerdi. Driveline hattı ve yüzeysel sternal yara enfeksiyonu oranları kontrol grubunda, çalışma grubuna göre
daha yüksek saptandı (sırasıyla p=0,003 ve p=0,018). Kontrol grubunda bir adet yüzeysel sternal yara yeri enfeksiyonu görüldü. Her iki grupta da
debridman gerektiren derin yara yeri enfeksiyonu görülmedi. Hastanede kalış süresi kontrol grubunda daha uzundu (p=0,05).

Sonuç: Bu çalışma ile kapalı insizyon negatif basınç tedavisinin driveline hattı enfeksiyonlarını, hastanede kalış süresini ve sağlık hizmetlerindeki
maliyet yükünü azaltmada etkisi olduğu sonucuna varılmıştır. Bu ön sonuçların, ventriküler destek cihazı implantasyonu prosedürleri sonrasında
profilaktik kapalı insizyon negatif basınç tedavisi uygulamasının avantajını desteklediği ve daha kapsamlı çalışmalar için temel bilgi teşkil ettiği
görülmektedir.

Keywords

Kapalı insizyon negatif basınç tedavisi , driveline hattı enfeksiyonları , yara enfeksiyonları , yara tedavisi

Ethical Statement

This retrospective study was approved by the Ankara University, Human Research Ethics Committee (approval no.: İ02-156-24, date: 06.03.2024).

Supporting Institution

-

Project Number

-

Thanks

-

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