Is vacuum‐assisted closure therapy feasible for children with deep sternal wound infection after cardiac surgery? The pooling results from current literature

Abstract

Objective Vacuum‐assisted closure (VAC) has been employed for children with deep sternal wound infections (DSWI), however, the safety and efficiency have not been determined. A meta‐analysis is performed for outcomes of VAC therapy in children with DSWI after cardiac surgery. Method Electronic databases, including PubMed, Scopus, and Cochrane Library CENTRAL were searched systematically from January 1990 to October 2020 for the literature which reported the outcomes of VAC therapy for children with DSWI after cardiac surgery. Meta‐regression and subgroup analyses were performed to find risk factors for prolonged length of VAC therapy and hospital stay. Results Eleven studies were included in this study, involving 217 subjects. VAC therapy was performed due to mediastinitis after congenital heart diseases repair. In children with DSWI after cardiac surgery, length of VAC therapy and hospital stay were 11.1 days (95%CI, 9.6 to 12.5 days) and 29.8 days (95%CI, 22.8 to 36.9 days), respectively. Incidence of infectious and wound‐related complications was 8.5% (95%CI, 4.1% to 13.0%). Overall mortality in this setting was 5.8% (95%CI, 2.5% to 9.1%). Conclusions In conclusion, in children with DSWI after cardiac surgery, length of VAC therapy and hospital stay are 11.1 days and 29.8 days, respectively. Overall mortality is 5.8%. Although not significant, delayed chest closure, complex CHD, and Gram‐negative bacilli/fungal infections may potentially contribute to prolonged duration of VAC treatment.