Evaluation of Absorbable Hemostatic Powder on Postoperative Outcomes in Patients Undergoing Mastectomy

Postoperative complications of mastectomy include seroma, hematoma, and infection. Hemostatic agents such as Arista AH absorbable hemostatic powder (AHP) is an FDA approved surgical adjunct to control intraoperative bleeding. This study evaluated the impact of AHP on postoperative outcomes in patients undergoing mastectomy.

Patients undergoing mastectomy between May 2022 and May 2024 were retrospectively identified from a prospectively maintained single-institution cancer registry. Inclusion criteria were patients undergoing therapeutic or prophylactic total mastectomy without immediate reconstruction. Statistical analysis included Chi-squared, Mann-Whitney U, and Student's t-tests.

Of 644 mastectomies, 45% received AHP and 55% did not. Hematoma occurred in 3.8% of the AHP group versus 7.9% in the no AHP group (P-value = .03). Seroma occurred in 22.2% of the AHP group versus 25% in the no AHP group (P-value = .41). Among patients with seroma or hematoma, postoperative infection rates were not significantly different regardless of AHP usage (P-value = .90). In patients who received AHP, a history of ipsilateral breast surgery was significantly associated with seroma (P-value = .02). In patients who did not receive AHP, neoadjuvant therapy (P-value = .02) and previous ipsilateral chest wall irradiation (P-value = .04) were significantly associated with seroma, while anticoagulation medication use was significantly associated with hematoma (P-value = .01) and seroma (P-value = .03).

In patients undergoing mastectomy without immediate reconstruction, AHP use was associated with decreased hematoma rate, with no differences in seroma, infection, or drain duration. Hematoma and seroma rates were increased in patients on peri‑operative anticoagulation who did not receive AHP, suggesting that AHP use may benefit select patient populations.