Variation in hospital resource use and cost among surgical procedures using topical absorbable hemostats

Martyn, Derek; Meckley, Lisa M.; Miyasato, G.; Lim, Sangtaeck; Riebman, Jerome B.; Kocharian, Richard; Scaife, J.; Rao, Yajing; Corral, Mitra

doi:10.2147/ceor.s88698

Cited by 13 publications

(13 citation statements)

References 18 publications

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“… 10 Hemostatic costs have been shown to be substantially lower for ORC products, such as SF, when compared to other adjunctive hemostats. 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

An in vivo comparison of the efficacy of hemostatic powders, using two porcine bleeding models

Macdonald¹,

Wang²,

Clymer³

et al. 2017

MDER

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BackgroundUsage of topical hemostatic agents in surgery is increasing, including use during minimally invasive procedures, and even for surgeries that have a low risk of bleeding complications. A novel product, Surgicel® Powder – Absorbable Hemostatic Powder (SP), made from oxidized regenerated cellulose (ORC) fabric, has been developed for adjunctive use in surgical procedures to assist in control of oozing bleeding over broad areas and where access could be difficult with a fabric ORC product. This study compares the new SP to other commercially available hemostatic powder products in two in vivo models.MethodsHemostatic efficacy of SP was compared to two polysaccharide-based hemostats in a porcine liver punch biopsy model and to three polysaccharide-based hemostats and one non-regenerated oxidized cellulose hemostat in a porcine liver abrasion model. Primary outcomes measured were hemostatic efficacy, defined as hemostasis within 10 minutes of application, and time-to-hemostasis (TTH).ResultsIn the punch biopsy model, SP displayed significantly higher effective hemostasis rates than one of the polysaccharide hemostats (p=0.047) and faster TTH than both (p<0.001). In the liver abrasion model, SP had significantly higher effective hemostasis rates (p≤0.002) and faster TTH (p<0.001) than the other four hemostatic agents. The amount of powder applied within the ranges used did not appear to affect hemostatic efficacy.ConclusionIn both the liver punch biopsy model of mild to moderate bleeding and the liver abrasion model of mild but diffuse oozing, SP provided more effective hemostasis and faster TTH than other marketed hemostatic powders. The results from this in vivo study suggest that Surgicel Powder may be useful in clinical applications where control of oozing capillary, mild venous, and small arterial hemorrhage is required including bleeding in difficult-to-access locations.

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“… 10 Hemostatic costs have been shown to be substantially lower for ORC products, such as SF, when compared to other adjunctive hemostats. 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

An in vivo comparison of the efficacy of hemostatic powders, using two porcine bleeding models

Macdonald¹,

Wang²,

Clymer³

et al. 2017

MDER

Self Cite

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“…Reduced bleeding may also translate into shorter operating times, shorter hospital stays, and improved patient outcomes. 1,3,4,5,7,15,16,17 Limitations of this retrospective data analysis warrant caution in the interpretation of the results. 18 Of primary concern is potential bias resulting from uncontrolled confounders, and so these results should be considered exploratory in nature.…”

Section: Discussionmentioning

confidence: 95%

Real-world Bleeding Outcomes and Costs Following Vascular Graft Anastomosis Using PROLENE Sutures with HEMO-SEAL Technology in Patients Undergoing Abdominal Aortic Aneurysm Repair

Sutton¹,

Schmitz²

2017

JHEOR

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Background: Suture hole bleeding is a common complication of vascular graft anastomosis that has potential to prolong vascular procedures, increase costs, and compromise patient outcomes.</p> Objectives: Compare real-world bleeding-related outcomes and costs following vascular anastomosis using PROLENE sutures with HEMO-SEAL technology (HEMO-SEAL sutures) compared with standard PROLENE sutures in patients receiving abdominal aortic aneurysm (AAA) repair in the United States. Methods: AAA repair procedures using hemostats and either HEMO-SEAL sutures or standard PROLENE sutures were identified from 2009 to 2013 using the Premier Healthcare Database. The primary outcome was the number and cost of hemostat units. Secondary outcomes were number and cost of sutures, bleeding complications, and transfusions. Results: A total of 5082 discharges for AAA repairs using hemostats and HEMO-SEAL sutures or standard PROLENE sutures were identified. HEMO-SEAL sutures were used in 79 (1.6%) discharges, standard PROLENE sutures were used in 4946 (97.3%); both sutures (excluded from the analysis) were used in 57 (1.1%). Discharge demographics were similar across suture groups, with the exception of disease severity; the HEMO-SEAL suture group had a higher proportion of minor discharges and a lower proportion of extreme discharges compared with the standard PROLENE suture group. Mean number of hemostat units used per discharge (2.34 vs 3.30; median = 2.0 in both groups; p=0.026) and median hemostat costs per discharge ($111 vs $186; p<0.01) were significantly lower in the HEMO-SEAL suture group compared with the standard PROLENE suture group. Fewer sutures per discharge (p<0.0001), lower mean costs of sutures per discharge, higher median costs of sutures per discharge (p=0.0045), and fewer transfusions (0.0019) were also seen in the HEMO-SEAL suture group compared with the standard PROLENE suture group. No statistically significant difference in bleeding complications was observed between suture groups. Conclusion: The results indicate that real-world use of HEMO-SEAL sutures may be associated with reduced hemostat usage and costs, and reduced bleeding that requires additional hemostats and/or transfusions.

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“…Using a combination powder such as CP may result in decreased operating room time, eliminate the need for operating room staff to prepare the hemostat, reduce operating room waste by avoiding the need for any preprepared product, enhance the safety of the patient by reducing delays in achieving hemostasis, and potentially save cost. Additional studies have examined time to hemostasis and included preparation or application times as well as the importance of hemostatic agent selection in influencing clinical outcomes and treatment costs . Operating room time and waste are becoming more prevalent concerns .…”

Section: Discussionmentioning

confidence: 99%

Prospective, multicenter, randomized, controlled trial evaluating the performance of a novel combination powder vs hemostatic matrix in cardiothoracic operations

et al. 2019

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Aim: This trial compared the hemostatic performance of a novel combination powder (CP) to a control hemostatic matrix (HM) in cardiothoracic operations.Methods: Patients meeting eligibility criteria were enrolled after providing informed consent. Subjects were randomized intraoperatively to receive CP (HEMOBLAST Bellows; Biom'up, France) or HM (FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, CA). Bleeding was assessed using a clinically validated, quantitative bleeding severity scale. The primary endpoint was total time to hemostasis (TTTH), from the start of device preparation, as an indicator of when a surgeon asks for a surgical hemostat until hemostasis was achieved. TTTH at 3 minutes was utilized for the primary analysis, while TTTH at 5 minutes was considered as a secondary endpoint.Results: A total of 105 subjects were enrolled across four institutions. The primary efficacy endpoint for the superiority of CP relative to HM for success at achieving hemostasis within 3 minutes was met, with 64.2% of the CP group achieving hemostasis compared with 9.6% of the HM group, a difference of 54.54% (37.4%-71.6%; P < .001 for superiority). The secondary efficacy endpoint was also met, with 92.5% of the CP group achieving hemostasis at 5 minutes versus 44.2% in the HM group, a difference of 48.2% (31.1%-65.4%; P < .001 for noninferiority). There were no device-related adverse events.Conclusions: In this multicenter, randomized, controlled trial, comparison of CP to HM revealed CP superiority and noninferiority for TTTH at 3 and 5 minutes, respectively.

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Variation in hospital resource use and cost among surgical procedures using topical absorbable hemostats

Cited by 13 publications

References 18 publications

An in vivo comparison of the efficacy of hemostatic powders, using two porcine bleeding models

An in vivo comparison of the efficacy of hemostatic powders, using two porcine bleeding models

Real-world Bleeding Outcomes and Costs Following Vascular Graft Anastomosis Using PROLENE Sutures with HEMO-SEAL Technology in Patients Undergoing Abdominal Aortic Aneurysm Repair

Prospective, multicenter, randomized, controlled trial evaluating the performance of a novel combination powder vs hemostatic matrix in cardiothoracic operations

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