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Comparison of Vacuum-Assisted Closure Therapy Versus Conventional Treatment for Post-sternotomy Mediastinitis: A
Md Intekhab Akram1, Faiz Khan Yusufi2, Syed Shamayal Rabbani1
1Cardiothoracic Surgery, Jawaharlal Nehru Medical College, Aligarh, IND.
Insights
Vacuum-assisted closure (VAC) therapy offers an effective treatment for poststernotomy mediastinitis, reducing hospital stay and complications. This approach can serve as a bridge to reconstructive surgery, improving patient outcomes and satisfaction.
Area of Science:
- Cardiothoracic Surgery
- Infectious Disease Management
- Wound Healing Research
Background:
- Median sternotomy is standard for cardiac surgeries, but deep sternal wound infections (DSWI) or mediastinitis can occur despite preventative measures.
- Poststernotomy mediastinitis presents a significant challenge in cardiac surgery recovery.
- Understanding infection risks post-median sternotomy is crucial for patient management.
Purpose of the Study:
- To evaluate the efficacy of vacuum-assisted closure (VAC) therapy compared to conventional treatment for poststernotomy mediastinitis.
- To assess the impact of VAC therapy on hospital stay, treatment duration, and patient outcomes.
- To determine if VAC therapy can reduce the need for further aggressive surgical interventions.
Main Methods:
- Retrospective analysis of 36 patients diagnosed with mediastinitis after cardiac surgery between October 2016 and December 2023.
- Patients were divided into two groups: Group 1 (n=20) treated with vacuum-assisted closure (VAC) therapy and Group 2 (n=16) treated with conventional methods.
- Data collected included demographics, clinical information, comorbidities, and treatment outcomes.
Main Results:
- The VAC therapy group showed a shorter average hospital stay (13 days vs. 23 days) and treatment duration (16 days vs. 22 days) compared to the conventional group.
- Fewer patients in the VAC group required prolonged intensive care unit (ICU) admission (16 vs. 8 patients needing >3 days).
- Mortality rates were comparable (5% in VAC group vs. 6.25% in conventional group), with deaths attributed to multiorgan failure from sepsis.
Conclusions:
- Vacuum-assisted closure (VAC) therapy is an effective treatment for poststernotomy mediastinitis, accelerating wound healing and closure.
- VAC therapy can serve as a valuable alternative or bridge to reconstructive surgery, improving patient condition and satisfaction.
- This approach may lead to fewer complications, reduced need for aggressive surgery, and potentially lower healthcare costs.
Background:
A median sternotomy is widely utilised as the standard approach for open cardiac surgeries to manage heart conditions like heart failure, valve disorders, irregular heart rhythms as part of arrhythmia surgery, aneurysms, and coronary artery disease, with coronary artery bypass grafting (CABG) being a common procedure. Despite the application of proper aseptic techniques, perioperative antibiotics, and meticulous wound care, surgical site infections, such as deep sternal wound infections (DSWI) or mediastinitis, can still develop.
Methodology:
Between October 2016 and December 2023, 1,542 osteotomies were performed on patients undergoing cardiac surgeries in the Department of Cardiothoracic and Vascular Surgery, Jawaharlal Nehru Medical College, Aligarh. Thirty-six patients (2.34%) were diagnosed with mediastinitis post-cardiac surgery. These patients were analysed retrospectively for demographics and clinical information comprising of medical history, vital signs, findings from a comprehensive clinical examination, laboratory results, comorbidities, prior surgeries, duration of hospital stay, and the indication for the current procedure, and two groups were formed: Group 1 (n = 20), who were treated with vacuum-assisted closure (VAC) therapy, and Group 2 (n = 16), who received conventional treatment.
Results:
The mean age of patients in the vacuum-assisted closure group was 38.9 ± 4.5 years, while the conventional treatment group had a mean age of 43.6 ± 5.0 years; other baseline characteristics were comparable in both groups. The average length of hospital stay after VAC therapy was 13 ± 2.5 days, with 16 patients requiring intensive care unit admission for more than three days. The conventional treatment group had an average stay of 23 ± 3.2 days, with eight patients needing ICU care for over three days. The duration of treatment, calculated from the time of mediastinitis diagnosis, was 16 days in the VAC group compared to 22 days in the conventional treatment group. The mortality rate in our study was 5% in the VAC therapy group and 6.25% in the conventional treatment group. Both patients who died did so due to multiorgan failure resulting from severe sepsis.
Conclusion:
VAC therapy can be considered a good alternative to more aggressive surgery that might not be suitable for some patients during certain times of their treatment course. It can also be used as a bridge to reconstructive surgery by improving the wound situation and the patient's general condition. This will improve the clinical outcome and patient satisfaction. VAC therapy for poststernotomy mediastinitis is an effective treatment, which speeds up wound granulation tissue formation and accelerates wound closure with decreased need for more aggressive reconstructive surgery. Moreover, accelerated wound closure may be associated with fewer complications and reduced expenses.
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