| ObjectiveSternal Wound Infection(SWI)is one of the complications after sternotomy.Currently,Negative Pressure Wound Therapy(NPWT)has been widely used in clinical practice.However,many single center studies have only explored the preventive and therapeutic effects of NPWT in the development of SWI,and further confirmation is needed for its role in the prevention and treatment of SWI.This study systematically and comprehensively collected existing clinical evidence,using meta-analysis methods to systematically evaluate the preventive and therapeutic effects of NPWT on SWI,in order to provide higher-level evidence-based medical evidence for future clinical decision-making.MethodsThe database is searched by computer.The Chinese database includes China National Knowledge Infrastructure,Wanfang Database,China Biology Medicine disc and VIP database,and the English database includes PubMed,Embase and The Cochrane Library.The retrieval time interval is from database establishment to December 2022.After the retrieval,the literature was screened and the literature quality was evaluated,and data were extracted from the outcome indicators of prevention(incidence of SWI)and therapy(in-hospital mortality,recurrence rate of SWI,duration of antibiotic use,duration of intensive care,and total duration of hospital stay)of the included literature.The statistical analysis process was carried out by using the Review Manager 5.3 software.For the binary variables,we selected the relative risk(RR)as the effect-size index,and calculated the 95%confidence interval(CI).After the combination,P<0.05 thought that the difference was statistically significant;For continuous variables,we choose the mean difference(MD)as the effect-size index,and calculate the 95%CI.After the combination,P<0.05,the difference is considered statistically significant.ResultsA total of 20 articles were included,8 articles exploring the preventive effect and 12 articles exploring the therapeutic effect.In terms of preventive effects,NPWT was effective in reducing the incidence of SWI compared with conventional dressings(RR=0.50;95%CI:0.38～0.65;P<0.001).In terms of therapeutic effects,compared to promote infection resolution measures such as conventional dressings,closed retrosternal lavage,daily open lavage and open tamponade with dressings,NPWT was effective in reducing in-hospital mortality(RR=0.25;95%CI:0.15～0.44;P<0.001),reducing recurrence rate of SWI(RR=0.17;95%CI:0.10～0.31);P<0.001),reducing the total duration of hospital stay(MD=-8.06;95%CI:-12.38～-3.74;P<0.001)and reducing the duration of antibiotic use(MD=-1.50;95%CI:-2.14～-0.85;P<0.001);For duration of intensive care,there was no significant difference between NPWT and the control group(MD=-4.90;95%CI:-9.75～-0.06;P=0.050).ConclusionIn terms of preventive effect,compared with conventional dressings,NPWT can reduce the incidence of SWI,and it is recommended that NPWT be routinely applied to high-risk groups of SWI after sternotomy to prevent the occurrence of SWI;In terms of therapeutic role,compared with conventional dressings,closed retrosternal lavage,daily open lavage,and open tamponade with dressings,which promote infection resolution measures,NPWT can reduce patients’ in-hospital mortality,recurrence rate of SWI,reduce the duration of antibiotic use,total duration of hospital stay,thus reducing patients’ distress and accelerating patients’recovery,it is recommended that NPWT can be used after the occurrence of SWI to promote inflammation resolution or to create favorable conditions for late closure and chest wall reconstruction. |
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