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RES235
Efficacy of Negative Pressure Wound Therapy (NPWT) in Obese and Diabetic Patients after Open Heart Surgery
By: J. Pasion, M. Wooten, & B. Atkins; Durham VA Medical Center
For further information, please contact: jpasion@nc.rr.com
Purpose: This study aims to determine whether the immediate placement of wound vacs for negative pressure wound therapy (NPWT) in diabetic and/or obese cardiac surgery patients undergoing median sternotomy has efficacious benefits in preventing sternal wound complications and reducing hospital re-admission.
Background/Significance: In the past fiscal year, subject facility performed 175 cardiac surgical procedures via median sternotomy. Approximately, 40% of patients had significant underlying conditions, particularly obesity and diabetes. Historically, it costs our institution between $11,500 to $40,000 per case to treat patients with superficial or deep sternal wound infections or frank mediastinitis arising from cardiac surgery. The study is an evidentiary tool to determine if immediate application of NPWT in high risk patients undergoing cardiac surgery reduces sternal wound healing.
Methods: Between January 2007 and June 2007, 27 patients were treated with NPWT after median sternotomy for cardiac surgery. GranuFoam Silver sponges were used exclusively (CABG, n=12; CABG/Valve, n=1; Valve, n=5; other, n=1). The sternal wound vac had a uniform negative pressure of -120mmHg. The majority of patients receiving NPWT were either obese (body mass index > 30, n=19) and/or diagnosed diabetics (n=10). The mean age was 63.1 years and 94.7% (n=26) were male. To maintain consistency in sternal wound care, dressings were replaced by the same cardio-thoracic surgeon and/or clinical wound care nurse specialist and removed after the fifth day of placement.
Results: The results show exceptional statistical significance that sternal wound vacs had a high probability (P=.001, n=19) in preventing the sternal wound complications in obese patients; likewise, sternal wound vacs reflects (P=.001, n=10) positively in preventing sternal wound complications in patients who are both diabetic and obese. Furthermore, there were no incidence of hospital re-admissions due to sternal wound complications within 30 days from date of discharge from this sample group (n=19).
Conclusions: Based on actual observations and statistical analysis, there seems to be high evidence that the placement of a sternal wound vac is efficacious in preventing sternal wound complications and eliminating hospital re-admissions when installed immediately after open heart surgery.
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