# Knowledge, Attitudes and Practices of Japanese Cardiovascular Surgeons on the Management of Surgical Site Complications and Prophylactic Single-Use Negative Pressure Wound Therapy After Coronary Artery Bypass Surgery: A Quantitative Survey

## TL;DR

This study explores how Japanese cardiovascular surgeons manage surgical site complications and use a wound therapy called sNPWT after heart surgery.

## Contribution

The study identifies barriers to the adoption of prophylactic sNPWT in Japan, including cost, reimbursement issues, and lack of awareness.

## Key findings

- Most surgeons agree that surgical site complications are severe after cardiovascular surgery.
- Only 2% of surgeons use sNPWT routinely, with cost and reimbursement being major barriers.
- Sixty percent of respondents believe Japan-specific sNPWT guidelines are needed.

## Abstract

Objective

This study assessed the knowledge, attitudes and practices of cardiovascular surgeons in Japan on prophylactic single-use negative pressure wound therapy (sNPWT) after coronary artery bypass grafting (CABG).

Methods

A survey was distributed online to an anonymous Japanese market research panel in April 2024 (target: 50 responses). Eligible respondents were cardiovascular surgeons practising in Japan, with five or more years of experience and having performed 20 or more CABG surgeries in the past year. Responses were analysed descriptively.

Results

Among the 50 respondents (38% general, 30% national/public, 24% university hospitals), most agreed that the consequences of surgical site complications (SSCs) following cardiovascular surgery were more severe than other surgeries (78%), that SSC prevention is a priority after CABG (80%), and that postoperative procedures are important for managing SSC risk (84%). However, sNPWT was rarely used routinely (2%). Only 24% reported prophylactic sNPWT use; 44% used sNPWT only upon signs of SSCs. Cost-related factors were important to 60‒70% of respondents in determining SSC prevention. There was low knowledge of approved indications and reimbursement criteria for sNPWT. While 52% would recommend prophylactic sNPWT, limited reimbursement (80%) and insufficient familiarity with safety (52%) and effectiveness (50%) data were reasons for non-use. Sixty percent of respondents agreed that Japan-specific sNPWT guidelines are needed.

Conclusions

Barriers to using prophylactic sNPWT in Japan include complex and limited reimbursement criteria, cost concerns, insufficient local evidence and low awareness of existing evidence. Addressing these challenges may encourage prophylactic sNPWT use, leading to reduced postoperative complications, lower healthcare costs, and minimised disparities in care.