Thirdly, surgical technique is described superficially: authors provide no details on the use of bone wax to the cut edges of the sternum for hemostasis. Further, no mention is made as to the mortality and morbidity in these groups of patients, the need for sternal reconstruction, hospital length of stay, readmissions, and whether these outcomes differed amongst the groups. and topical prophylaxis is to be condemned. The above information is crucial and failure to understand the synergy between iv. Secondly, authors claimed to “have performed a single center study yet had limited data on details about administration of systemic perioperative antibiotics”. In fact, risk ratio for the above numbers is 0.67 (0.19–2.31) with level of significance P=0.52 which puts the statistical testing behind the above RCT in doubt. is severely biased and must be interpreted with caution, in particular because it was the first RCT of topically used vancomycin in cardiac surgery to ever get published.įirstly, the study is obviously underpowered for DSWI with literature reported incidence ranging between 2–3%, adequately powered study (1:1 randomization ratio 80% power, alpha 0.05) should enroll at least 1,500 subjects to detect the difference authors report P value for comparison of 0.07 we are not aware of any appropriate statistical test of 4/138 vs. While we acknowledge and commend any scientific effort in the field of SWI prevention, the study by Pervaiz et al. 6 (4.3%) however, this was not statistically significant (P=0.07). The incidence of DSWI in the vancomycin group versus normal saline group was found to be 4 (2.9%) vs. in the recent issue of Journal of Surgery and Surgical Research reports on a randomized trial of 276 patients scheduled for elective CABG and divided into two equal groups one receiving 0.2 vancomycin saline solution ‘sprinkled’ over a sternal wound, while the other group received a spray of normal saline ( 5). Since then other studies were made available that unexpectedly pointed to zero benefit with topical antibiotics when analysed in detail, however, they present certain methodological flaws which make interpretation of their biased results cumbersome. This recommendation for the first time was given class I-which stands for “procedure/treatment should be performed”. Based on the available evidence, an expert consensus was issued on behalf of American Association for Thoracic Surgery (AATS) stating that “topical antibiotics should be applied to the cut edges of the sternum on opening and before closing all cardiac surgical procedures involving a sternotomy.” ( 4). Several meta-analyses have been published in attempt to pool the above studies in search for definite conclusions ( 2, 3). Numerous studies have been published so far however differing in methodology and topical agent employed which poses difficulties in comparison of their sometimes conflicting results. However, there is a continuously heated discussion whether this procedure has scientific justification. Among them vancomycin and gentamycin have been used extensively. Use of topical antibiotics aside intravenous prophylaxis has been of growing interest among cardiothoracic surgeons with many facilities applying it routinely. Interviews with Outstanding Guest Editorsįigure 1 Complicated deep sternal wound infection.Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.
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