Gentamicin-collagen sponge reduces the risk of sternal wound infections after heart surgery: Meta-analysis Mariusz Kowalewski, MD, Wojciech Pawliszak,

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Gentamicin-collagen sponge reduces the risk of sternal wound infections after heart surgery: Meta-analysis Mariusz Kowalewski, MD, Wojciech Pawliszak, MD, Katarzyna Zaborowska, RN, Eliano Pio Navarese, MD, PhD, Krzysztof Aleksander Szwed, MD, Magdalena Ewa Kowalkowska, MD, Janusz Kowalewski, MD, PhD, Alina Borkowska, MD, PhD, Lech Anisimowicz, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 6, Pages 1631-1640.e6 (June 2015) DOI: 10.1016/j.jtcvs.2015.01.034 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Flow diagram of the review process according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Total number of patients is reduced by N = 967 because of the exact control group in 2 studies.3,5 ICGS, Implantable gentamicin-collagen sponge. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Summary analysis of primary end point SWI. RRs and 95% CIs. Size of squares is proportional to the statistical weight of each trial. Diamonds represent RR point estimates; horizontal lines represent CIs for given point estimate; positioning of both diamonds and squares (along with CIs) beyond the vertical line (unit value) suggests significant outcome. Meta-regression analysis of the logRR of primary end point on the percentage of patients receiving BITA (B) and SITA (C) grafts. Size of circles corresponds to the number of patients in each study. BITA, Bilateral internal thoracic artery; CI, confidence interval; df, degrees of freedom; IGCS, implantable gentamicin-collagen sponge; M-H, Mantel–Haenszel; SITA, single internal thoracic artery. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Summary analysis of DSWI. RRs and 95% CIs. Size of squares is proportional to the statistical weight of each trial. Diamonds represent RR point estimates; horizontal lines represent CIs for given point estimate; positioning of both diamonds and squares (along with CIs) beyond the vertical line (unit value) suggests significant outcome. Meta-regression analysis of the logRR of DSWI on the percentage of patients receiving BITA (B) and SITA (C) grafts. Size of circles corresponds to the number of patients in each study. BITA, Bilateral internal thoracic artery; CI, confidence interval; df, degrees of freedom; M-H, Mantel–Haenszel; SITA, single internal thoracic artery. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Summary analysis of SSWI. RRs and 95% CIs. Size of squares is proportional to the statistical weight of each trial. Diamonds represent RR point estimates; horizontal lines represent CIs for given point estimate; positioning of both diamonds and squares (along with CIs) beyond the vertical line (unit value) suggests significant outcome. Meta-regression analysis of the logRR of SSWI on the percentage of patients receiving BITA (B) and SITA (C) grafts. Size of circles corresponds to the number of patients in each study. BITA, Bilateral internal thoracic artery; CI, confidence interval; df, degrees of freedom; M-H, Mantel–Haenszel; SITA, single internal thoracic artery. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Efficacy of implantable gentamicin-collagen sponge in preventing sternal wound infections. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Summary analysis of mediastinitis. RRs and 95% CIs. Size of squares is proportional to the statistical weight of each trial. Diamonds represent RR point estimates; horizontal lines represent CIs for given point estimate; positioning of both diamonds and squares (along with CIs) beyond the vertical line (unit value) suggests significant outcome. CI, Confidence interval; df, degrees of freedom; M-H, Mantel–Haenszel. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Summary analysis of mortality. RRs and 95% CIs. Size of squares is proportional to the statistical weight of each trial. Diamonds represent RR point estimates; horizontal lines represent CIs for given point estimate; positioning of both diamonds and squares (along with CIs) beyond the vertical line (unit value) suggests significant outcome. CI, Confidence interval; df, degrees of freedom; M-H, Mantel–Haenszel. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Sensitivity analysis for the primary end point conducted by deleting each single study at time and repeating the calculations. Analysis indicates no single study influenced the overall effect. CI, Confidence interval; IGCS, implantable gentamicin-collagen sponge. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Yearly numbers of patients developing SWIs at the Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz plotted against the total number of surgeries and number of surgeries with IGCS implantation. IGCS, Implantable gentamicin-collagen sponge; SWI, sternal wound infection. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 1631-1640.e6DOI: (10.1016/j.jtcvs.2015.01.034) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions