Background Bleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality. This study evaluated the impact of bleeding on length of stay (LOS) and critical care utilization in a nationwide sample of cardiac surgery patients treated at English hospitals. Methods Retrospective, observational cohort study using linked English Hospital Episode Statistics (HES) and Clinical Practice Research Datalink (CPRD) records for a nationwide sample of patients aged ≥18 years who underwent coronary artery bypass graft (CABG), valve repair/replacement, or aortic operations from January 2010 through February 2016. The primary independent variables were in-hospital bleeding complications and reoperation for bleeding before discharge. Generalized linear models were used to quantify the adjusted mean incremental difference [MID] in post-procedure LOS and critical care days associated with bleeding complications, independent of measured baseline characteristics. Results The study included 7774 cardiac surgery patients (3963 CABG; 2363 valve replacement/repair; 160 aortic procedures; 1288 multiple procedures, primarily CABG+valve). Mean LOS was 10.7d, including a mean of 4.2d in critical care. Incidences of in-hospital bleeding complications and reoperation for bleeding were 6.7 and 0.3%, respectively. Patients with bleeding had longer LOS (MID: 3.1d; p < 0.0001) and spent more days in critical care (MID: 2.4d; p < 0.0001). Reoperation for bleeding was associated with larger increases in LOS (MID = 4.0d; p = 0.002) and days in critical care (MID = 3.2d; p = 0.001). Conclusions Among English cardiac surgery patients, in-hospital bleeding complications were associated with substantial increases in healthcare utilization. Increased use of evidence-based strategies to prevent and manage bleeding may reduce the clinical and economic burden associated with bleeding complications in cardiac surgery. Electronic supplementary material The online version of this article (10.1186/s13019-019-0881-3) contains supplementary material, which is available to authorized users.

Physicians consistently reported high EUQ scores for the fibrin sealant patch across surgical bleeding populations. An important limitation of this study was that the composition of SoC varied across studies and EUQ data were only available for the SoC in two of four trials. Future studies should evaluate ease of use for other hemostats and across other surgical subspecialties, as data are currently limited.

BackgroundDespite hemostat use, uncontrolled surgical bleeding is prevalent. Drawbacks of current hemostats include limitations with efficacy on first attempt and suboptimal ease-of-use. Evarrest® is a novel fibrin sealant patch that has demonstrated high hemostatic efficacy compared with standard of care across bleeding severities. The objective of this study was to conduct a hospital cost analysis of the fibrin sealant patch versus standard of care in soft tissue and hepatic surgical bleeding.MethodsThe analysis quantified the 30-day costs of each comparator from a hospital perspective. Published US unit costs were applied to resource use (ie, initial treatment, retreatment, operating time, hospitalization, transfusion, and ventilator) reported in four trials. A “surgical” analysis included resources clinically related to the hemostatic benefit of the fibrin sealant patch, whereas a “hospital” analysis included all resources reported in the trials. An exploratory subgroup analysis focused solely on coagulopathic patients defined by abnormal blood test results.ResultsThe surgical analysis predicted cost savings of $54 per patient with the fibrin sealant patch compared with standard of care (net cost impact: −$54 per patient; sensitivity range: −$1,320 to $1,213). The hospital analysis predicted further cost savings with the fibrin sealant patch (net cost impact of −$2,846 per patient; sensitivity range: −$1,483 to −$5,575). Subgroup analyses suggest that the fibrin sealant patch may provide dramatic cost savings in the coagulopathic subgroup of $3,233 (surgical) and $9,287 (hospital) per patient. Results were most sensitive to operating time and product units.ConclusionIn soft tissue and hepatic problematic surgical bleeding, the fibrin sealant patch may result in important hospital cost savings.

unheated CO2 (U-CO2) in laparoscopic patients. Efficacy data were derived from a published randomised controlled trial reporting on the proportion of patients with hypothermia, a US database analysis of hypothermia patients for open surgery, and from an unpublished UK NHS before and after study of laparoscopic surgery patients. Other parameter inputs were obtained from published literature. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of results. Scenario analyses were undertaken to explore structural uncertainty within the model. Results: The use of WH-CO2 dominated standard care, as it was both cost saving and generated greater QALYs, for both open and laparoscopic surgery patients over a one year time horizon. Results varied by the number of patients undergoing surgery per humidifier per year. Based on 250 patients using the humidifier each year over a five year lifetime of the humidifier, WH-CO2 dominated no insufflation in open surgery patients in 71% of model iterations and dominated U-CO2 in laparoscopic surgery in 98% of model iterations. WH-CO2 remained the cost-effective treatment option at a willingness-to-pay threshold of £20,000 per QALY throughout all scenario and sensitivity analyses considered, provided 10 or more patients used each humidifier over its life span. ConClusions: The analyses conducted suggest that based upon the currently available clinical evidence, WH-CO2 is a cost-effective use of resources for patients undergoing either open or laparoscopic colorectal surgery within the UK NHS.

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