Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes
Background:. Infected Ventricular Assist Device (VAD)–associated wounds are common and associated with significant morbidity and mortality. The efficacy of hardware salvage utilizing flaps and negative pressure wound therapy (NPWT) remains understudied. We hypothesized that patients treated with fla...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2022-10-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004627 |
| _version_ | 1811197921434009600 |
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| author | Robert C. Clark, BS Marco A. Swanson, MD Yida Cai, MD Anuja L. Sarode, MPH Kyle D. Lineberry, MD Anand R. Kumar, MD |
| author_facet | Robert C. Clark, BS Marco A. Swanson, MD Yida Cai, MD Anuja L. Sarode, MPH Kyle D. Lineberry, MD Anand R. Kumar, MD |
| author_sort | Robert C. Clark, BS |
| collection | DOAJ |
| description | Background:. Infected Ventricular Assist Device (VAD)–associated wounds are common and associated with significant morbidity and mortality. The efficacy of hardware salvage utilizing flaps and negative pressure wound therapy (NPWT) remains understudied. We hypothesized that patients treated with flaps and/or NPWT would have higher hardware salvage rates compared with other surgical management strategies.
Methods:. A meta-analysis study evaluating VAD-associated wounds was performed following PRISMA guidelines. Primary predictor variables were flap-reconstruction (FR), NPWT, no FR, and infection location (mediastinum versus driveline). Primary outcomes were hardware retention (salvage) versus explantation, infection recurrence, or death. Twenty-nine studies were included. Standard statistical methods included logistic regression analysis.
Results:. Seventy-four subjects with nonsignificant demographic differences between cohorts were identified. Overall salvage was 59.5% in both driveline and mediastinum cohorts. Overall, NPWT significantly improved salvage compared with no NPWT [77.4% versus 46.5% respectively (P = 0.009)], and FR significantly improved salvage compared with no FR [68.6% versus 39.1% respectively (P = 0.022)]. Logistic regression analysis predicting odds of salvage by FR (area under curve = 0.631) was significantly three times higher (95% CI: 1.2–9.5) and predicting the odds for salvage by NPWT (area under curve = 0.656) was significantly four times higher (95% CI: 1.4–11.1) compared with other treatment.
Conclusions:. NPWT or flap reconstruction for treatment of threatened VAD hardware was associated with a significantly improved device salvage compared with other surgical strategies. Further study should focus on subgroup analysis of flaps utilized and synergistic treatment benefits. |
| first_indexed | 2024-04-12T01:22:23Z |
| format | Article |
| id | doaj.art-ca38e57e636f4a89851a09fc444084d2 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-12T01:22:23Z |
| publishDate | 2022-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-ca38e57e636f4a89851a09fc444084d22022-12-22T03:53:45ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742022-10-011010e462710.1097/GOX.0000000000004627202210000-00050Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction OutcomesRobert C. Clark, BS0Marco A. Swanson, MD1Yida Cai, MD2Anuja L. Sarode, MPH3Kyle D. Lineberry, MD4Anand R. Kumar, MD5From the * Case Western Reserve University School of Medicine, Cleveland, Ohio† Department of Plastic & Reconstructive Surgery, University Hospitals, Cleveland, OhioFrom the * Case Western Reserve University School of Medicine, Cleveland, Ohio‡ Research in Surgical Outcomes and Effectiveness (UH-RISES), Cleveland, Ohio.† Department of Plastic & Reconstructive Surgery, University Hospitals, Cleveland, Ohio† Department of Plastic & Reconstructive Surgery, University Hospitals, Cleveland, OhioBackground:. Infected Ventricular Assist Device (VAD)–associated wounds are common and associated with significant morbidity and mortality. The efficacy of hardware salvage utilizing flaps and negative pressure wound therapy (NPWT) remains understudied. We hypothesized that patients treated with flaps and/or NPWT would have higher hardware salvage rates compared with other surgical management strategies. Methods:. A meta-analysis study evaluating VAD-associated wounds was performed following PRISMA guidelines. Primary predictor variables were flap-reconstruction (FR), NPWT, no FR, and infection location (mediastinum versus driveline). Primary outcomes were hardware retention (salvage) versus explantation, infection recurrence, or death. Twenty-nine studies were included. Standard statistical methods included logistic regression analysis. Results:. Seventy-four subjects with nonsignificant demographic differences between cohorts were identified. Overall salvage was 59.5% in both driveline and mediastinum cohorts. Overall, NPWT significantly improved salvage compared with no NPWT [77.4% versus 46.5% respectively (P = 0.009)], and FR significantly improved salvage compared with no FR [68.6% versus 39.1% respectively (P = 0.022)]. Logistic regression analysis predicting odds of salvage by FR (area under curve = 0.631) was significantly three times higher (95% CI: 1.2–9.5) and predicting the odds for salvage by NPWT (area under curve = 0.656) was significantly four times higher (95% CI: 1.4–11.1) compared with other treatment. Conclusions:. NPWT or flap reconstruction for treatment of threatened VAD hardware was associated with a significantly improved device salvage compared with other surgical strategies. Further study should focus on subgroup analysis of flaps utilized and synergistic treatment benefits.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004627 |
| spellingShingle | Robert C. Clark, BS Marco A. Swanson, MD Yida Cai, MD Anuja L. Sarode, MPH Kyle D. Lineberry, MD Anand R. Kumar, MD Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes Plastic and Reconstructive Surgery, Global Open |
| title | Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes |
| title_full | Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes |
| title_fullStr | Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes |
| title_full_unstemmed | Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes |
| title_short | Threatened Ventricular Assist Devices: Meta-analysis of Negative Pressure Therapy and Flap Reconstruction Outcomes |
| title_sort | threatened ventricular assist devices meta analysis of negative pressure therapy and flap reconstruction outcomes |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004627 |
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