Major Reduction Of Sternal Wound Infections After Open Heart Surgery Using The Posthorax Sternum Vest
Results Of A Large Prospective Randomised Multi-Center Trial
Postoperative wound complications after cardiac surgery are still one of the major causes of morbidity and mortality.
Infections acquired during health care, such as sternal complications result in prolonged hospital stays, greater consumption of antibiotics, revision surgery and greater consumption of resources, all culminating in unpredictably high treatment costs.
Restrictions on the reimbursement of medical expenses, particularly in the last years, have magnified the importance of preventing post-surgical complications. Postoperative care must be focused on the patients’ well-being and prudent use of resources.
A multi-centre study was performed by the Cardiac Surgery Department of Vienna, Hamburg and Nuernberg, MDs M Gorlitzer, F Wagner and S Pfeiffer at Al.
From September 2007 to March 2010, 2539 patients undergoing cardiac surgery via median sternotomy were prospectively randomized into those who received a Posthorax® vest and those who did not.
Patients were instructed to wear the vest postoperatively for 24 h a day for at least 6 weeks; the duration of follow-up was 90 days. Statistical calculations were based on an intention-to-treat (ITT) analysis.
Complete data were available for 2539 patients, 1351 were randomised to receive a vest, while 1188 received no vest. No significant differences were observed between groups.
RESULTS
The frequency of deep wound complications (mediastinitis and sternal dehiscence) was significantly lower in the vest group (1.04%) versus the non-vest (2.27% patients (ITT, P < 0.01), but superficial complications did not differ between groups.
Sub-analysis of vest patients revealed that only 933 (Group A) wore the vest according to the protocol, while 202 (Group BR) refused to wear the vest (non-compliance) and 216 (Group BN) did not use the vest for other reasons.
All dWC occurred in Groups BR (n = 7) and BN (n = 7), although these groups had the same preoperative risk profile as Group A.
Postoperatively, Group BN (No Vest) had a prolonged intubation time, a longer stay in the intensive care unit, greater use of intra-aortic balloon pump, higher frequency of COPD and a larger percentage of patients who required prolonged surgery.
In conclusion the study finds consistent use of the Posthorax® vest prevented deep sternal wounds. The anticipated risk factors for wound complications did not prove to be relevant, whereas intra- and postoperative complications appear to be very significant.
Link to the study: https://pubmed.ncbi.nlm.nih.gov/23760221/
For more information: info@posthorax.com
