LAUSR

Limited and conflicting evidence exists on whether bone wax usage in cardiac surgery increases risk of infection. A systematic review was conducted to examine the cardiac surgery postoperative outcomes following bone wax application. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to in this review. The EMBASE, MEDLINE and Scopus databases were searched for studies evaluating perioperative bone wax usage, excluding non-English papers. All relevant synonyms of Cardiac Surgery, Bone Wax, Infection, and Healing were used for paper identification. Wound infection, sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality were outcomes of interest. From the 66 articles identified, 5 were included following full-text screening. No statistically significant difference in infection risk between the bone wax (BW) and comparator groups existed. However, the evidence suggests bone wax significantly increases sternal dehiscence risk. Studies reporting postoperative bleeding showed a significantly greater mean volume in the BW group. All studies reporting postoperative chest drainage (n=3) showed a greater mean volume in the BW group, of which two were significant. Of the three papers reporting mortality, two showed increased risk in the BW group. Current evidence indicates no significant association between bone wax and wound infection. Bone wax is associated with increased risk of sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality. Greater emphasis should be placed on bone wax alternatives in clinical practice. Limited data necessitates larger studies, and for clearer guidelines to be established around them.