EVALUATION OF PLATELET RICH PLASMA IN REDUCING STERNAL WOUND COMPLICATIONS IN CABG SURGERY WITH MEDIAN STERNOTOMY

Abstract

Introduction
Sternal wound complications, including superficial wound infection (SWI) and deep sternal wound infections (DSWI), are serious concerns following coronary artery bypass grafting (CABG) after conventional median sternotomy. Platelet-Rich Plasma (PRP) has been proposed as an adjunct therapy to improve wound healing and reduce infection rates. This study aimed to study PRP’s effects on reducing sternal wound complications in the patients of CABG.

Objectives

To ascertain the effect of PRP application on the prevalence of delayed wound healing and superficial and deep sternal wound infections (SWI and DSWI) in patients having CABG surgery with median sternotomy.

Study Design
Randomized controlled trial.

Duration
Six months following the acceptance of the study protocol.

Setting
The study was conducted in the Department of Cardiac Surgery, Cardiac Center, Pakistan Institute of Medical Sciences (PIMS), Islamabad.

Methods
The study included 98 patients aged 45 to 72 years, undergoing on-pump CABG. Participants were randomly assigned to two groups: the control group, which received standard sternal closure, and the study group, which received additional autologous PRP application during sternal closure. Participants and outcome assessors are blinded to group assignment, while surgeons performing the procedure are aware of the intervention. Wound healing, deep and superficial infection including mediastinitis, and readmissions within 30 days will be documented as primary outcomes. Secondary outcome will be the overall cost burden for the 30-days post-surgery period. Other outcomes will be ICU stay (days), blood transfusions more than 4 units and platelets transfusions more than 4 units. Data were analyzed using SPSS version 23, with a chi-square test applied to compare incidences of SWI, DSWI, and delayed healing between groups.

Results
The use of PRP significantly decreased the incidence of superficial wound infection 4.1% as compared to the control group 16.3%. Similarly, deep sternal wound infections notably decreased with no DSWI in Group B as compared to control group 8.2%. Delayed healing was also remarkably decreased in the PRP group. Overall, PRP was related with better postoperative outcomes and a decrease in hospital readmissions, contributing to lower healthcare costs in the 30-day postoperative period.

Conclusions

Autologous PRP application remarkably reduces the risk of sternal wound complications, such as superficial and deep infections and delayed wound healing, in patients undergoing CABG with median sternotomy.