Variables Associated with Treatment Failure after Negative Pressure Wound Therapy in Poststernotomy Mediastinitis: A Case–Control Study

Abstract

Background

This study investigated factors leading to treatment failure after negative pressure wound therapy (NPWT) in poststernotomy mediastinitis (PSM) patients.

Methods

A single-center retrospective case–control study in 198 cardiac surgery patients with PSM and consecutive NPWT were retrospectively divided into two groups. Group I consisted of patients whose NPWT was successful (n = 117/198; 59.1%), while in Group II treatment, failure occurred (n = 81/198; 40.9%). The primary endpoint was treatment failure, defined as recurrence of wound infection requiring surgical treatment within 30 days after secondary wound closure.

Results

Body mass index (BMI) >30 kg/m² (p = 0.04; odds ratio [OR] 1.07), diabetes mellitus (DM; p = 0.03; OR 1.94), and the number of sponge changes (p = 0.01; OR 1.57) showed an association with the occurrence of NPWT failure. During the study period, 10/198 (19.8%) patients died after secondary wound healing. In group I, 1/117 (0.9%) patient died versus group II with 9/81 (12.7%) patients. About 70% patients died from septic multiple organ failure.

Conclusion

This study confirms that variables associated with treatment failure after NPWT in PSM are BMI >30 kg/m², diabetes mellitus (DM), and the “number of sponge changes,” respectively. However, this does not mean that sponge changes increase the risk; rather, sponge changes are associated with more resistant germs, incomplete wound healing, and more aggressive infection. This implies that management should be in the hands of cardiac surgeons with extensive experience in septic surgery and at centers with expertise in order to minimize the duration of NPWT and thus the number of sponge changes.

Keywords

poststernotomy mediastinitis - negative pressure wound therapy - therapy failure

Publikationsverlauf

Eingereicht: 09. Mai 2025

Angenommen: 28. Oktober 2025

Accepted Manuscript online:
30. Oktober 2025

Artikel online veröffentlicht:
13. November 2025

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