title: Patterns of use of hemostatic agents in patients undergoing major surgery.
abstract: BACKGROUND
  Although a number of prohemostatic agents that are applied intraoperatively have been introduced to minimize bleeding, little is known about the patterns of use and the factors that influence use. We examined the use of hemostatic agents in patients undergoing major surgery.
  
  
  METHODS
  All patients who underwent major general, gynecologic, urologic, cardiothoracic, or orthopedic surgery from 2000-2010 who were recorded in the Perspective database were analyzed.
  
  
  RESULTS
  Among 3,633,799 patients, hemostatic agents were used in 30.3% (n = 1,102,267). The use of hemostatic agents increased from 28.5% in 2000 to 35.2% in 2010. Over the same period, the rates of transfusion declined for pancreatectomy (-14.4%), liver resection (-15.0%), gastrectomy (-11.7%), prostatectomy (-6.6%), nephrectomy (-4.6%), hip arthroplasty (-10.4%), and knee arthroplasty (-6.6%). Over the same time period, the transfusion rate increased for colectomy (6.0%), hysterectomy (3.7%), coronary artery bypass graft (8.4%), valvuloplasty (4.2%), lung resection (1.9%), and spine surgery (1.6%). Transfusion remained relatively stable for thyroidectomy (0.2%).
  
  
  CONCLUSIONS
  The use of hemostatic agents has increased rapidly even for surgeries associated with a small risk of transfusion and bleeding complications. In addition to patient characteristics, surgeon and hospital factors exerted substantial influence on the allocation of hemostatic agents.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York; Herbert Irving Comprehensive Cancer Center, New York, New York. Electronic address: jw2459@columbia.edu.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Zainab
authors.initials: Z
authors.lastname: Siddiq
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative
chemical_list: D006490:Hemostatics
keywords: Bleeding; Blood; Hemorrhage; Hemostasis; Hemostatic agents