手術部位感染症ハイリスク患者に対する予防的陰圧閉鎖療法

Prophylactic Negative Pressure Wound Therapy for Patients at High Risk of Surgical Site Infection in Cardiovascular Surgery

手術部位感染症（SSI）は予防しうる周術期合併症の一つであるが，一定の頻度での発生をみる．特に心臓血管外科領域においては，胸骨正中切開創に伴う深部胸骨創部感染（deep sternal wound infection：DSWI）は1～10％の頻度と報告されている1）．DSWIの発生は時に患者の生命を脅かすとともに，治療にかかる人的・医療費コストも増大する．縦隔洞炎の発生は短期予後に影響するのみでなく，長期予後にも影響を及ぼすことも明らかとなっている2）．

Background：Deep sternal wound infection after cardiovascular surgery is one of the most devasting complications in both a short and long term. The addition of prophylactic negative pressure wound therapy （pNPWT） to standard surgical site infection （SSI） prophylaxis could be promising approach for the reduction of this problem.

Methods：We evaluated 117 consecutive patients who underwent median sternotomy for cardiovascular surgery at our institution from July 2021 to December 2021. pNPWT with Prevena system was used for patients at high risk of SSI. The incidence of SSI was considered.

Results：There were 50 patients in pNPWT group and 67 in the usual management group. The estimated risk of SSI was significantly higher in the pNPWT group （2.9±2.3％ vs 1.7±1.3％, p＜0.05）, but there was no significant difference in the incidence of SSI.

Conclusion：Prophylactic negative wound therapy in cardiovascular surgery may reduce the incidence of SSI to normal levels in a group of patients at high risk of SSI.