Use of Topical Insulin vs Placebo for reducing Median Sternotomy Complications after Cardiac Surgery in Diabetic Patients

Abstract

Objective To assess the potential benefits of adding topical insulin to standard postoperative care in diabetic patients undergoing cardiac surgery.

Methodology: A quasi-experimental study was conducted in the Department of Cardiac Surgery, Cardiac Center, Pakistan Institute of Medical Sciences, Islamabad from 01-6-2022 to 30-5-2023. Patients in the intervention group received a spray consisting of 1 cc of 0.9% saline mixed with 10 units (0.1 cc) of insulin per 10 cm² of the wound area during sternal closure. This topical application on the wound was continued twice daily for 30 days postoperatively. The control group received standard of care sternal closure and treatment. Patients were monitored for 30 days following surgery. Primary outcomes included wound healing, the occurrence of deep and superficial infections and hospital re-admissions within the 30-day period.

Results: Mean age of patients in insulin treated and control group was 59.31±6.16 years vs 59.82±6.17 years (p=0.683). Although not statistically significant, the Insulin treated patients showed better results as compared to the control group with reduced sternal wound infections (2.0% vs 8.2%, p=0.168), less delayed healing (6.1% vs 14.3%, p=0.182) and lower readmissions (4.1% vs 6.1%, p=0.646).

Conclusion: The application of topical insulin to median sternotomy wounds in diabetic patients showed improved results with better healing and reduced complications within the 30-day postoperative period.