The Effect of Bone Wax Application in Cardiac Surgery: A Systematic Review

Abstract Aim There is limited and conflicting evidence on whether bone wax usage in cardiac surgery increases infection risk. A systematic review was conducted to examine cardiac surgery postoperative outcomes following bone wax application. Method This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The MEDLINE, EMBASE, and Scopus databases were searched for studies evaluating perioperative bone wax usage in the English language. All relevant synonyms of “Cardiac Surgery”, “Bone wax”, “Infection”, and “Healing” were used to identify papers. The outcomes of interest were wound infection, sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality. Results From the 66 articles found, 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 the risk of sternal dehiscence. 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 an increased risk in the BW group. Conclusions Current evidence indicates no significant association between bone wax and wound infection. Bone wax is associated with a greater 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.