Gelatin-thrombin hemostatic matrix in neurosurgical procedures: hemostatic effectiveness and economic value of clinical and surgical procedure-related benefits.

Abstract

BACKGROUND:

Gelatin-thrombin hemostatic matrix (FloSeal®) use is associated with shorter surgical times and less blood loss, parameters that are highly valued in neurosurgical procedures. We aimed to assess the effectiveness of gelatin-thrombin in neurosurgical procedures and estimate its economic value.

METHODS:

In a 6-month retrospective evaluation at 2 hospitals, intraoperative and postoperative information were collected from patients undergoing neurosurgical procedures where bleeding was controlled with gelatin-thrombin matrix or according to local bleeding control guidelines (control group). Study endpoints were: length of surgery, estimated blood loss, hospitalization duration, blood units utilized, intensive care unit days, postoperative complications, and time to recovery. Statistical methods compared endpoints between the gelatin-thrombin and control groups and resource utilization costs were estimated.

RESULTS:

Seventy-eight patients (38 gelatin-thrombin; 40 control) were included. Gelatin-thrombin was associated with a shorter surgery duration than control (166±40 versus 185±55 minutes, P=0.0839); a lower estimated blood loss (185±80 versus 250±95 mL; P=0.0017); a shorter hospital stay (10±3 versus 13±3 days; P<0.001); fewer intensive care unit days (10 days/3 patients and 20 days/4 patients); and shorter time to recovery (3±2.2 versus 4±2.8 weeks; P=0.0861). Fewer gelatin-thrombin patients experienced postoperative complications (3 minor) than the control group (5 minor; 3 major). No gelatin-thrombin patient required blood transfusion; 5 units were administered in the control group. The cost of gelatin-thrombin (€ 268.40/unit) was offset by the shorter surgery duration (difference of 19 minutes at € 858/hour) and the economic value of improved the other endpoint outcomes (i.e., shorter hospital stay, lesser blood loss/lack of need for transfusion, fewer intensive care unit days, and complications).

CONCLUSIONS:

The use of gelatin-thrombin hemostatic matrix in patients undergoing neurosurgical procedures was associated with better intra- and postoperative parameters than conventional hemostasis methods, with these parameters having substantial economic benefits.

• Authors: Felice Esposito, Paolo Cappabianca, Filippo F Angileri, Luigi M Cavallo, Stefano M Priola, Salvatore Crimi, Domenico Solari, Antonino F Germanò, Francesco Tomasello
• Journal: Journal of neurosurgical sciences (J Neurosurg Sci) Vol. 64 Issue 2 Pg. 158-164 (Apr 2020) ISSN: 1827-1855 [Electronic] Italy
• PMID: 27456032 (Publication Type: Journal Article)

Chemical References

• Hemostatics
• Gelatin
• Thrombin

Topics

• Adult
• Blood Loss, Surgical (prevention & control)
• Blood Transfusion (economics)
• Female
• Gelatin (blood)
• Hemostatics (blood, economics)
• Humans
• Length of Stay (economics)
• Male
• Middle Aged
• Neurosurgical Procedures (methods)
• Postoperative Complications
• Thrombin (metabolism)
• Time Factors