Thorax support vest to prevent sternal wound infections in cardiac surgery patients-a systematic review and meta-analysis.

OBJECTIVES: Midline sternotomy is the main surgical access for cardiac surgeries. The most prominent complication of sternotomy is sternal wound infection (SWI). The use of a thorax support vest (TSV) that limits thorax movement and ensures sternal stability has been suggested to prevent postoperative SWI. We performed a meta-analysis to evaluate differences in clinical outcomes with and without the use of TSV after cardiac surgery in randomized trials.

METHODS: The primary outcome was deep SWI (DSWI). Secondary outcomes were superficial SWI (SSWI), sternal wound dehiscence, and hospital length of stay (LOS). A trial sequential analysis (TSA) was performed. Fixed (F) and random effects (R) model were calculated.

RESULTS: A total of 4 studies (3,820 patients) were included. Patients who wore the TSV had lower incidence of DSWI (OR= F : 0.24, 95% CI, 0.13-0.43, p < 0.01; R : 0.24, 0.04-1.59, p = 0.08), of sternal wound dehiscence (OR= F : 0.08, 95% CI, 0.02-0.27, p < 0.01; R : 0.10, 0.00-2.20, p = 0.08) and shorter hospital LOS (SMD= F:-0.30, -0.37 to -0.24, p < 0.01; R:-0.63, -1.29 to 0.02, p = 0.15). There was no difference regarding the incidence of SSWI (OR= F : 0.71, 95% CI, 0.34-1.47, p = 0.35; R : 0.64, 0.10, 4.26, p = 0.42). The TSA however showed that the observed decrease in DSWI in TSV arm cannot be considered conclusive based on the existing evidence.

CONCLUSIONS: This meta-analysis suggests that the use of a TSV after cardiac surgery could potentially be associated with a reduction in sternal wound complications. However, despite the significant treatment effect in the available studies, the evidence is not solid enough to provide strong practice recommendations.