Effect of Hemostatic Material on Sternal Healing After Cardiac Surgery

• Published in: The Annals of thoracic surgery Vol. 97; no. 1; pp. 153 - 160
• Main Authors: Vestergaard, Rikke F., MD, Nielsen, Per H., MD, Terp, Kim A., MD, Søballe, Kjeld, DMSc, MD, Andersen, Gratien, MD, Hasenkam, John M., DMSc, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 2014
• Subjects: Administration, Topical; Aged; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Denmark; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - methods; Female; Follow-Up Studies; Hemostatics - pharmacology; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative - prevention & control; Palmitates - pharmacology; Poloxamer - pharmacology; Prospective Studies; Reference Values; Risk Assessment; Single-Blind Method; Sternotomy - adverse effects; Sternotomy - methods; Surgery; Surgical Wound Infection - diagnostic imaging; Surgical Wound Infection - drug therapy; Time Factors; Tomography, X-Ray Computed - methods; Treatment Outcome; Waxes - pharmacology; Wound Healing - drug effects; Wound Healing - physiology; 18
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2013.08.030

Background Postoperative sternal infection and dehiscence cause increased morbidity, mortality, and socioeconomic costs as well as patient discomfort and pain. Some predisposing factors have been uncovered but others remain uninvestigated. Among these are the influence of topical hemostatic agents such as bone wax (BW) and Ostene (Ceremed Inc, Los Angeles, CA) a new, water-soluble polymer wax (WSW). The object of this study was to investigate the impact of topical hemostatic agents on sternal healing in patients. Methods In total, 50 patients subjected to elective cardiac surgery and requiring intraoperative hemostatic treatment were randomized to 1 of 2 treatment groups: BW or WSW. Twenty-five patients without need for sternal hemostasis constituted a control group. The doctors analyzing the endpoints were blinded to the treatment. Radiologic bone healing was assessed by a radiologist using computed tomography at 3 and 6 months postoperatively. Quality of life and bodily pain was assessed by questionnaires (Short Form-36 and Visual Analogue Scale). Results No patients displayed complete radiologic healing at 3 months. Bone healing (evaluated semi-quantitatively at a score from 0 to 10) was significantly impaired in the BW group compared with both the control and WSW groups at both 3 and 6 months postoperatively ( p < 0.0001). Radiologic bone healing was positively correlated with physical functioning score (Short Form-36) ( p < 0.001). Pain scores were generally low (<1) at both 3 and 6 months with no significant difference between study groups. Conclusions The results from this study suggest that WSW provides a useful alternative to BW when topic hemostasis on the sternum is required.