Different Strategies in Management of Deep Sternal Wound Infection

Abstract

Abstract Background The consequences of Deep Sternal wound infection (DSWI) can be catastrophic with increased morbidity and mortality, and decreased life expectancy, so one must have a low threshold for diagnosis and a clear management algorithm. Several approaches to the treatment of DSWI have been described, with no real consensus as to the single best specific treatment methodology. This study will compare the outcome of different strategies in management of deep sternal wound infection. Objective To systematically review the outcome after different methods in management of deep sternal wound infection. To compare between outcome data of different methods in management of deep sternal wound infection. Materials and Methods We prepared this systematic review with a careful following of the Cochrane Handbook for Systematic Reviews of Interventions. We also adhered to The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines during the design of our study. Results We obtained 98 articles from PubMed, 161 articles from Scopus, 0 article from Cochrane library and 122 from web of science. 141 duplicated articles were removed using Endnote X8 program (Thompson Reuter, USA), 240 articles manually underwent titles and Abstracts screening and 107 articled underwent full-text review. Conclusion Ten studies with a total number of 940 patients who underwent treatment with either traditional surgery or VAC for management of DSWI, the mean age of included cases was around 70 years old, with nearly equal distribution of male and female gender. The pooled estimate of meta-analysis showed there is no statistically significant difference between both groups regarding length of hospital stay (MD = 3.44, 95%CI = [-8.47, 15.35], or length of ICU admission (MD = 0.29, 95%CI = [-3.66, 4.23], there is no statistically significant difference between both groups regarding survival outcomes on the short term (30-day mortality, 90-day mortality and hospital mortality), mid-term (one year mortality and one year survival) and long term (two and five years survival), (OR = 1.63, 95%CI = [0.07, 37.1]), (OR = 0.40, 95%CI = [0.07, 2.11]), (OR = 1.61, 95%CI = [0.57, 4.52]) and (OR = 1.75, 95%CI = [0.64, 4.79]) respectively. No significant difference between either group regarding treatment failure, reoperation rate nor recurrent sternal fistulas (OR = 0.58, 95%CI = [0.01, 38.52]), (OR = 0.91, 95%CI = [0.23, 3.57]), (OR = 0.91, 95%CI = [0.23, 3.57]) respectively. On the other hand, VAC showed a significantly lower infection rate in comparison with surgery (OR = 0.26, 95%CI = [0.13, 0.55]).