EFFICIENCY OF VACUUM THERAPY IN TREATMENT OF POSTOPERATIVE STERNOMEDIASTINITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Objectives. Efficacy estimation of vacuum-assisted closure therapy (VAC) in comparison with conventional methods in the treatment of deep sternal infection following cardiothoracic surgery by carrying out systematic review and meta-analysis of study publications devoted to the given problem. Methods. A systematic search was conducted (PubMed, elibrary.ru, hand search) for studies dedicated to the comparative analysis of vacuum-assisted closure therapy efficacy and a conventional treatment of deep sternal infection (1997-2015 yrs). The Newcastle-Ottawa Scale (NOS) for assessing the quality of methodology of the study was used. Mortality was considered the primary outcome, secondary outcome - duration of therapy and disease recurrences. The results were presented as odds ratios (ORs) 95% of confidence interval (CI). Statistical heterogeneity was assessed using Q-test and I 2 -test. Results. For the analysis 26 non-randomized, retrospective, cohort studies published from 1997 to September 2015, including the results of treatment of postoperative sternal infections in 2616 patients were selected. It was found in the case of using the VAC-therapy the lethality was significantly lower than in conventional treatment (2233 patients; OR=0,40; 95% CI 0,28-0,57; р2 =0%). VAC-therapy use was associated with fewer recurrences (1322 patients; OR=0,27; 95% CI 0,16-0,45; р2 =23%). A significant reduction of the therapy duration had been revealed (1577 patients; mean difference -5,86 days; 95% CI -9,40: -1,08; р=0,02) with high heterogeneity between studies (I 2 =87%). Conclusion. The systematic review and meta-analysis suggest that VAC- therapy might be more effective than a conventional one in treatment of deep sternal infections. However, randomized studies are required to confirm the potential value of this type of treatment.