Closed-Incision Negative-Pressure Wound Therapy in Bypass Surgery: Evidence and Implications for Personalized Care

Objectives: Sternal wound infections (SWIs) after cardiac surgery remain a major complication and represent a significant clinical challenge. This article aims to evaluate the effectiveness of closed-incision negative-pressure wound therapy (ciNPWT) in preventing postoperative wound complications in high-risk patients undergoing coronary bypass surgery via full median sternotomy. Methods: Data on all consecutive patients undergoing coronary artery bypass surgery at our facility between March 2021 and March 2023 were retrospectively collected. The ciNPWT group consisted of 71 patients. A control group receiving conventional wound dressings was selected by propensity matching. The primary outcome was postoperative sternal wound complication of any severity, as well as superficial and deep SWIs. The secondary outcomes were hospital stay length, in-hospital mortality, and need for perioperative wound revision. Results: The incidence of postoperative SWIs was significantly higher in the ciNPWT group than in the control group (18 [25.4%] vs. 7 [9.9%], p = 0.03). Of these 25 cases, 20 had received postoperative ciNPWT and 5 conventional wound dressings, which was statistically different (15 [21.1%] vs. 5 [7.0%], p = 0.03). ciNPWT was also significantly associated with positive bacterial cultures (13 [18.3%] vs. 4 [5.6%], p = 0.04) and perioperative wound revision (11 [15.5%] vs. 6 [8.5%], p = 0.05). Conclusions: In consecutive high-risk patients undergoing coronary bypass surgery, the use of prophylactic ciNPWT did not improve wound healing compared to conventional wound dressings, raising concerns about its effectiveness in high-risk patients. Our results do not support the routine use of ciNPWT in this setting. Its potential value may instead lie in carefully defined patient subgroups, underscoring the relevance of our findings for patient-tailored care strategies in cardiac surgery.