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Thorac Cardiovasc Surg
DOI: 10.1055/a-2733-4361
Original Cardiovascular

Treatment failure after negative pressure wound therapy in post-sternotomy mediastinitis

Authors

  • Christoph Schimmer

    1   Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany

  • Christina Heinowski

    2   Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany

  • Khaled Hamouda

    1   Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany

  • Patrick Meybohm 

    3   Dept of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wurzburg, Wurzburg, Germany (Ringgold ID: RIN27207)

  • Nodir Madrahimov

    4   Department of Thoracic and Cardiovascular Surgery, Julius-Maximilians-University Hospital Wuerzburg, Wuerzburg, Germany

  • Gloria Färber 

    1   Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany

  • Dejan Radakovic

    1   Department of Cardiothoracic- and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
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Background: This study investigated factors leading to treatment failure after negative pressure wound therapy (NPWT) in post-sternotomy 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%). Primary end-point was treatment failure, defined as re-occurrence of wound infection requiring surgical treatment within 30 days after secondary wound closure. Results: BMI > 30 kg/m2 (p=0.04; OR 1.07), Diabetes mellitus (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 died 1/117 (0.9%) patient versus group II with 9/81 (12.7%) patients. 70% patients died from septic multiple organ failure. Conclusion: This study confirms that variables associated with treatment failure after negative pressure wound therapy in post-sternotomy mediastinitis are BMI > 30 kg/m2, Diabetes mellitus, and the "number of sponge changes", repectively. 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.



Publication History

Received: 09 May 2025

Accepted after revision: 28 October 2025

Accepted Manuscript online:
30 October 2025

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