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Effect of microporous polysaccharide particles in patients undergoing mastectomy

      Clinical Practice Points

      • Microporous polysaccharide particles are used for surgical hemostasis. Our original study aims to promote high-quality care to breast surgical oncology patients through additional safety evaluation of this product. Existing data regarding this hemostatic agent is inconclusive to its benefit; a prior randomized control trial for this product in breast surgery patients required early closure related to funding. MPP remains a well-utilized hemostatic agent at our medical center, although its effects have not been evaluated retrospectively for our patient population. Given these considerations, we aimed to evaluate outcomes for mastectomy patients without reconstruction treated with and without MPP. We did not note a difference between the treatment groups, in terms of hematoma, infection, or time to drain removal. Our findings suggest that MPP can be considered in patients undergoing axillary surgery, such as lymphovenous anastomosis, to potentially reduce the risk of seroma.

      Abstract

      BACKGROUND

      Microporous polysaccharide particles (MPP, proprietary name “Arista AH”), derived from purified plant starch, are used to augment hemostasis at surgery. The effect of MPP regarding short-term complications after mastectomy remains an area of ongoing investigation.

      PATIENTS AND METHODS

      A single-institution, retrospective chart review of patients undergoing unilateral mastectomy without reconstruction from January 2019 to 2021 was performed. Primary endpoints included antibiotic prescription, seroma or abscess drainage, readmission, wound dehiscence, and time to drain removal within 30 days of initial surgery. Wilcoxon rank sum test or Student T test was used for group comparisons for continuous variables; Chi-square test or Fisher exact test was used to evaluate the associations among categorical variables.

      RESULTS

      190 patients were included; 119 received MPP and 71 did not. There was no difference in antibiotic prescription, infection drainage, hematoma, readmission, dehiscence, or time to drain removal with regards to MPP use. MPP treated patients were older (65.8 years vs 59.1, p<0.001) and had lower albumin levels (4.1 g/dL vs 4.3, p=0.025). Patients who underwent abscess drainage had higher body mass index (BMI, mean 36.1 vs 30.1 p=0.036). Patients requiring seroma drainage were more likely to be diabetic (12.8% vs 4%, p=0.035) and to have been treated with lymphovenous anastomosis (LVA, 15.6% vs 3.8%, p=0.009). Patients who had LVA were significantly less likely to receive MPP when compared to other groups (3.1% vs 74.7% p<0.001).

      CONCLUSION

      Consider utilizing MPP in patients at higher risk of seroma, such as those undergoing axillary surgery including LVA.
      Microabstract
      Microporous polysaccharide particles (MPP), a hemostatic agent, were evaluated for post-operative outcomes. 190 patients were retrospectively reviewed. No difference was noted between those treated with and without MPP with regards to infection, seroma, or hematoma. Lymphovenous anastomosis (LVA) patients were more at risk of seroma and less likely to receive MPP. Consider utilizing MPP in this LVA population.

      Keywords

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