AQUACEL® Ag Advantage reduces the stress of postoperative packing removal after endoscopic sinus surgery

Kei Hosoya; Yohei Maeda; Taro Komachi; Kazuki Sato; Kimihiro Okubo

doi:10.1016/j.bjorl.2023.101292

AQUACEL® Ag Advantage reduces the stress of postoperative packing removal after endoscopic sinus surgery

Braz J Otorhinolaryngol. 2023 Sep-Oct;89(5):101292. doi: 10.1016/j.bjorl.2023.101292. Epub 2023 Jul 18.

Authors

Kei Hosoya¹, Yohei Maeda², Taro Komachi³, Kazuki Sato⁴, Kimihiro Okubo⁵

Affiliations

¹ Musashi Kosugi Hospital, Nippon Medical School, Department of Otolaryngology, Nakahara-Ku, Kawasaki, Japan; Tama Nagayama Hospital, Nippon Medical School, Department of Otolaryngology, Tama, Tokyo, Japan.
² Japan Community Health Care Organization Osaka Hospital, Department of Otorhinolaryngology, Fukushima, Osaka, Japan; Osaka University, Department of Otorhinolaryngology-Head and Neck Surgery, Suita, Japan. Electronic address: yohei4603@yahoo.co.jp.
³ Chiba Hokusoh Hospital, Nippon Medical School, Department of Otolaryngology, Inzai, Japan.
⁴ Tama Nagayama Hospital, Nippon Medical School, Department of Otolaryngology, Tama, Tokyo, Japan.
⁵ Nippon Medical School Hospital, Department of Otolaryngology, Head and Neck Surgery, Bunkyo-Ku, Tokyo, Japan.

Abstract

Objective: After Endoscopic Sinus Surgery (ESS), packing plays an important role in wound healing and hemostasis. However, the effect of the packing removal procedure on physician stress has not been evaluated. The purpose of this study was to evaluate physician stress during packing removal for patients treated with AQUACEL® Ag Advantage versus KALTOSTAT®.

Methods: This retrospective study included 15 patients who underwent packing with ESS for chronic rhinosinusitis performed at two centers; 9 were treated with AQUACEL® Ag Advantage and 6 were treated with KALTOSTAT®. Physician stress during packing removal was evaluated with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). The time required to remove the packing and the number of instruments used in the procedure were recorded. Postoperative bleeding (Boezaart bleeding score) and wound healing were graded. Patient symptoms on the day after surgery and pain during packing removal were assessed using a visual analog scale.

Results: Computed tomography scores, asthma complications, and blood eosinophil counts were significantly higher in the AQUACEL® Ag Advantage group. Patient symptoms on the day after surgery were not significantly different between the two groups. Physician stress during the task of packing removal was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (35.5 vs. 81.0, p=0.016) according to the NASA-TLX scores. The number of instruments used in the procedure was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (3.0 vs. 6.0, p=0.015). There were no significant differences in procedure time for packing removal, postoperative bleeding, wound healing, or patient pain at the time of packing removal between the groups.

Conclusion: Physicians feel stressed about packing removal. In addition, AQUACEL® Ag Advantage is useful for packing after ESS, requiring fewer instruments for the procedure than KALTOSTAT® and reducing physician stress about the procedure.

Level of evidence: Level 3.

Keywords: AQUACEL® Ag advantage; Endoscopic sinus surgery; Nasal packing; Stress.

MeSH terms

Alginates
Carboxymethylcellulose Sodium*
Endoscopy* / methods
Humans
Pain
Postoperative Hemorrhage
Retrospective Studies
Treatment Outcome

Substances

Carboxymethylcellulose Sodium
Alginates