title: Safety and efficacy of a surgeon-prepared gelatin hemostatic agent compared with FloSeal for hemostasis in laparoscopic partial nephrectomy.
abstract: OBJECTIVE
  Postoperative hemorrhage is a significant risk after laparoscopic partial nephrectomy (LPN). Hemostatic agents have become increasingly popular as adjuncts to renorrhaphy because of their potential to minimize intracorporeal suturing and lessen warm ischemia time. The objective of our study was to compare the safety and efficacy of an inexpensive, surgeon-prepared hemostatic agent with that of a more expensive, commercially prepared one.
  
  
  METHODS
  Between August 2006 and July 2008, 40 LPNs were performed by a single surgeon at two separate institutions. A commercially available gelatin matrix thrombin, FloSeal, was used at one institution (cohort 1, n=19), while a less expensive, surgeon-prepared gelatin hemostatic agent, Gelfoam, was used at a separate institution (cohort 2, n=21) over the same period. Outcomes, including estimated blood loss (EBL), operative time, transfusion rates, and complications, were compared between the two groups.
  
  
  RESULTS
  The median operative and warm ischemia times in cohorts 1 and 2 were 150 (range 132-192) and 16 (range 12-29) minutes and 150 (range 120-300) and 20 (range 14-37) minutes, respectively (P = 0.16, 0.07). The median EBL was 150 mL (range 50-250) and 100 mL (range 50-1000) (P = 0.09), and the postoperative transfusion rate was 0% and 4.8% (P = 0.33). Median LOS was 2 (range 2-7) and 3 (range 2-7) days (P = 0.62). Potential cost saved per case was $200 to $450.
  
  
  CONCLUSIONS
  As health care costs continue to rise, delivering high-quality care in a cost-effective manner is paramount. Our study demonstrates similar safety and efficacy of a surgeon-prepared, cheaper gelatin matrix compared with FloSeal. Generic hemostatic agents are a viable alternative to more expensive agents in institutions in which commercially available agents are not available or cost prohibitive.
authors.affiliation: The James Buchanan Brady Urologic Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA. tguzzo1@jhmi.edu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Guzzo
authors.forename: Richard A
authors.initials: RA
authors.lastname: Pollock
authors.forename: Allen
authors.initials: A
authors.lastname: Forney
authors.forename: Piyush
authors.initials: P
authors.lastname: Aggarwal
authors.forename: Brian R
authors.initials: BR
authors.lastname: Matlaga
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005780:Gelatin / Q000009:adverse effects* / Q000494:pharmacology*; D006487:Hemostasis / Q000187:drug effects*; D006490:Hemostatics / Q000009:adverse effects* / Q000494:pharmacology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010820:Physicians; D011182:Postoperative Care; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D005780:Gelatin