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Cost Effectiveness of Autologous Platelet-Rich Plasma for Cardiac Surgery: An Analysis of 2,000 Patients

A. N. Patel, C. H. Selzman, G. S. Kumpati, S. McKeller, D. A. Bull

University of Utah, School of Medicine, Salt Lake City

Purpose: Sternal wound complications following cardiac surgery increase morbidity, mortality, and cost. Autologous platelet-rich plasma (PRP) derived from the patient’s own blood has been used in other settings to promote successful wound healing. The goal of this study was to analyze the addition of PRP using a rapid point of care bedside system to standard wound care in all patients undergoing sternotomy for cardiac surgical procedures.

Methods: Over a 7-year period, 2,000 patients undergoing open cardiac operations requiring sternotomy were enrolled in the study. One thousand patients received standard of care sternal closure, including preoperative antibiotics and protocol-driven glycemic management. The other 1,000 patients received standard of care sternal closure plus PRP composed of platelet-rich plasma, calcium, and thrombin applied to the sternum at the time of closure. The outcomes related to wound healing, infection, readmissions, and costs were analyzed.

Results: Two thousand patients completed the study. There were no differences between the two groups with regard to age, weight, diabetes, renal dysfunction, smoking, or steroid use. There were more ventricular assist device implantations and open aortic operations in the PRP group compared to the control group. Compared to the control group, the use of PRP reduced the incidence of deep sternal wound infection from 2.0% to 0.6%*, superficial wound drainage from 8.0% to 2.0%*, and the readmission rate from 4.0% to 0.8%* (*= p<0.05). Multivariate analysis confirmed that the use of the PRP independently predicted a reduction in the incidence of deep sternal wound infection. There were no complications associated with the use of the PRP in the treatment group. Compared to the control group, the use of PRP reduced the costs associated with the development of deep and superficial wound complications from $1,256,960 to $593,791 (p<0.05).

Conclusions: The use of PRP decreases the incidence of sternal wound complications following cardiac surgery. Consequently, the use of PRP reduces the costs associated with the management of these sternal wound complications. The routine use of platelet-rich plasma should be considered for all patients undergoing sternotomy for cardiac surgical procedures.

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