RESUMEN
Aim: To assess the impact of oxidized regenerated cellulose (ORC) on blood transfusion and hospital costs associated with surgeries. Patients & methods: This retrospective cohort study selected ten surgeries to create propensity-score matching groups to compare ORC versus nonORC (conventional hemostatic techniques such as manual pressure, ligature and electrocautery). Results: NonORC was associated with both higher blood transfusion volume and higher hospital costs than ORC in endoscopic transnasal sphenoidal surgery, nonskull base craniotomy, hepatectomy, cholangiotomy, gastrectomy and lumbar surgery. However, nonORC was associated with better outcomes than ORC in open colorectal surgery, mammectomy and hip arthroplasty surgery. Conclusion: When compared with conventional hemostatic technique, using ORC could impact blood transfusion and hospital costs differently by surgical settings.
Asunto(s)
Celulosa Oxidada/economía , Celulosa Oxidada/uso terapéutico , Costos de la Atención en Salud/estadística & datos numéricos , Hemostáticos/economía , Hemostáticos/uso terapéutico , Costos de Hospital/estadística & datos numéricos , Hemorragia Posoperatoria/prevención & control , Pérdida de Sangre Quirúrgica/prevención & control , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Celulosa , China , Costos y Análisis de Costo , Humanos , Puntaje de Propensión , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos , Centros de Atención TerciariaRESUMEN
Background: Efficient hemostasis during lumbar surgery (LS) is associated with better perioperative outcomes. Flowable gelatin hemostatic matrix (FGHM) is a new type of absorbable hemostatic agent, which is effective to control bleeding during spinal surgery. This study aimed to assess the impact of FGHM on perioperative outcomes and hospital costs associated with LS. Methods: This study retrospectively analyzed medical and billing records of patients who underwent LS for spinal degenerative disease in a Chinese tertiary care hospital from 2014 to 2016. The identified patients were further stratified into a FGHM group (n = 108) (using the combination of FGHM and gelatin sponge) and a historical control group (using oxidized cellulose and/or collagen, n = 82) for the adjusted comparisons of the perioperative outcomes using a propensity score matching method. Multiple generalized linear regression was conducted to assess the impact of using FGHM on total hospitalization costs. Results: Comparisons of 64 propensity score matched pairs showed a significantly lower blood transfusion rate (34.4% vs 64.1%, p = 0.005), lower blood transfusion volume (182.7 ± 312.4 vs 301.3 ± 281.0 mL, p = 0.045), reduced post-surgery drainage tube placement rate (82.8% vs 93.8%, p = 0.046), and shorter post-operative days on antibiotics (6.0 ± 2.6 vs 7.1 ± 2.4 days, p = 0.010) in the FGHM group. Although with a relatively high acquisition price, the use of FGHM for hemostasis in LS did not increase the total hospitalization costs (coefficient = -0.001, p = 0.972). Conclusions: The use of FGHM in LS improved perioperative outcomes related to hemostatic effects without increasing overall hospital costs in a real-world hospital setting.
Asunto(s)
Esponja de Gelatina Absorbible/economía , Esponja de Gelatina Absorbible/uso terapéutico , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Adulto , Anciano , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , Celulosa Oxidada/economía , Celulosa Oxidada/uso terapéutico , China , Colágeno/economía , Colágeno/uso terapéutico , Femenino , Humanos , Tiempo de Internación , Modelos Lineales , Masculino , Persona de Mediana Edad , Tempo Operativo , Puntaje de Propensión , Características de la Residencia , Estudios Retrospectivos , Factores Socioeconómicos , Centros de Atención Terciaria/economía , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
Haemostasis is of fundamental significance in neurosurgery, and insufficient control of bleeding is associated with morbidity and mortality. Topical haemostatic agents play an important role, as the characteristics of neuronal tissue limit the use of classical surgical haemostasis techniques. Appropriate choice of agent depends on the location and type of bleeding, but also on knowledge of the products' mechanisms of action, indications, price and accessibility. Biological products are superior to the mechanical in efficacy but require more preparation and are significantly more cost-intensive.
Asunto(s)
Hemostasis , Hemostáticos , Procedimientos Neuroquirúrgicos/métodos , Pérdida de Sangre Quirúrgica/prevención & control , Celulosa Oxidada/administración & dosificación , Celulosa Oxidada/economía , Celulosa Oxidada/uso terapéutico , Colágeno/administración & dosificación , Colágeno/economía , Colágeno/uso terapéutico , Fibrina/administración & dosificación , Fibrina/economía , Fibrina/uso terapéutico , Hemostasis/efectos de los fármacos , Hemostasis/fisiología , Hemostáticos/administración & dosificación , Hemostáticos/economía , Hemostáticos/farmacocinética , Hemostáticos/uso terapéutico , Humanos , Peróxido de Hidrógeno/administración & dosificación , Peróxido de Hidrógeno/economía , Peróxido de Hidrógeno/uso terapéutico , Procedimientos Neuroquirúrgicos/economía , Palmitatos/administración & dosificación , Palmitatos/economía , Palmitatos/uso terapéutico , Cloruro de Sodio/administración & dosificación , Cloruro de Sodio/economía , Cloruro de Sodio/uso terapéutico , Tapones Quirúrgicos de Gaza/economía , Trombina/administración & dosificación , Trombina/economía , Trombina/uso terapéutico , Ceras/economía , Ceras/uso terapéuticoRESUMEN
OBJECTIVE: The use of hemostatic agents has increased over time for all surgical procedures. The purpose of this study was to evaluate the newer topical absorbable hemostat products Surgicel * Fibrillar and Surgicel SNoW (Surgicel advanced products, abbreviated as SAPs) compared to the older product Surgicel Original (SO) with respect to healthcare resource use and costs in procedures where these hemostats are most commonly used. RESEARCH DESIGN AND METHODS: A retrospective analysis of the Premier hospital database was used to identify adults who underwent brain/cerebral (BC), cardiovascular (CV: valve surgery and coronary artery bypass graft) and carotid endarterectomy (CEA) between January 2011-December 2012. Among these patients, those treated with SAPs were compared to those treated with SO. Propensity score matching (PSM) was used to create comparable groups to evaluate differences between SAPs and SO. MAIN OUTCOME MEASURES: The primary end-points for this study were length of stay (LOS), all-cause total cost, number of intensive care unit (ICU) days, ICU cost, transfusion costs and units, and SO/SAP product units per discharge. RESULTS: Matched PSM created patient cohorts for SO and SAPs were created for BC (n = 758 for both groups), CV (n = 3388 for both groups), and CEA (n = 2041 for both groups) procedures. Patients that received SAPs had a 14-16% lower mean LOS for each procedure compared to SO, as well as 12-18% lower total mean cost per discharge for each procedure (p < 0.02 for all results). Mean ICU costs for SAPs were also lower, with a reduction of 20% for BC and 19% for CV compared to SO (p < 0.01). However, for CEA, there was no statistically significant difference in ICU costs for SAPs compared to SO. CONCLUSIONS: In a retrospective hospital database analysis, the use of SAPs were associated with lower healthcare resource utilization and costs compared to SO.
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Procedimientos Quirúrgicos Cardiovasculares/economía , Procedimientos Quirúrgicos Cardiovasculares/métodos , Celulosa Oxidada/economía , Hemostáticos/economía , Precios de Hospital/estadística & datos numéricos , Procedimientos Neuroquirúrgicos/economía , Transfusión Sanguínea/economía , Celulosa Oxidada/administración & dosificación , Comorbilidad , Femenino , Hemostáticos/administración & dosificación , Humanos , Unidades de Cuidados Intensivos/economía , Tiempo de Internación/economía , Masculino , Persona de Mediana Edad , Modelos Econométricos , Estudios RetrospectivosRESUMEN
We used an economic model to assess the impact of using the GYNECARE INTERCEED absorbable adhesion barrier for reducing the incidence of postoperative adhesions in open surgical gynecologic procedures. Caesarean section surgery, hysterectomy, myomectomy, ovarian surgery, tubal surgery, and endometriosis surgery were modeled with and without the use of GYNECARE INTERCEED absorbable adhesion barrier. Incremental GYNECARE INTERCEED absorbable adhesion barrier material costs, medical costs arising from complications, and adhesion-related readmissions were considered. GYNECARE INTERCEED absorbable adhesion barrier use was assumed in 75% of all procedures. The economic impact was reported during a 3-year period from a United States hospital perspective. Assuming 100 gynecologic surgeries of each type and an average of one GYNECARE INTERCEED absorbable adhesion barrier sheet per surgery, a net savings of $540,823 with GYNECARE INTERCEED absorbable adhesion barrier during 3 years is estimated. In addition, GYNECARE INTERCEED absorbable adhesion barrier use resulted in 62 fewer cases of patients developing adhesions. Although the use of GYNECARE INTERCEED absorbable adhesion barrier added $137,250 in material costs, this was completely offset by the reduction in length of stay ($178,766 savings), fewer adhesion-related readmissions ($458,220 savings), and operating room cost ($41,078 savings). Adoption of the GYNECARE INTERCEED absorbable adhesion barrier for appropriate gynecologic surgeries would likely result in significant savings for hospitals, driven primarily by clinical patient benefits in terms of decreased length of stay and adhesion-related readmissions.
Asunto(s)
Implantes Absorbibles/economía , Celulosa Oxidada/economía , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Adherencias Tisulares/economía , Adherencias Tisulares/prevención & control , Celulosa Oxidada/uso terapéutico , Femenino , Humanos , Tiempo de Internación/economía , Modelos Económicos , Quirófanos/economía , Readmisión del Paciente/economía , Adherencias Tisulares/etiología , Estados UnidosRESUMEN
Prolonged air leak has been described in many pulmonary diseases but remains one of the common complications of pulmonary resections. Although, the management of prolonged air leaks related to broncho-pleural or alveolo-pleural fistulae traditionally requires surgical repair. In recent years, bronchoscopic approaches have drawn attention because of their conservative nature. We report a case of prolonged air leak after a pulmonary wedge resection that was treated with a simple and economical endobronchial method.