title: A cost-effective analysis of fibrin sealants versus no sealant following open right hemihepatectomy for colorectal liver metastases.
abstract: BACKGROUND
  There is paucity of data regarding the cost-effectiveness of fibrin sealants during liver surgery. This study aimed to assess the cost-effectiveness of fibrin sealants following right hemihepatectomy for colorectal liver metastases.
  
  
  METHODS
  A prospectively maintained database between 2004 and 2013 was reviewed to identify patients who underwent a right hemihepatectomy with and without fibrin sealant application. Perioperative and post-operative outcomes were analysed to assess its cost-effectiveness.
  
  
  RESULTS
  One hundred and sixty-three right hemihepatectomies were performed, of which 79 were in the fibrin sealant treatment group and 84 were in the no sealant group. No difference was seen between fibrin sealant and no sealant with regard to bile leak (P = 0.366), intra-abdominal collections (P = 0.200) and overall post-operative complications (P = 0.480). Operating costs were significantly cheaper in the no sealant group (P = 0.010). There was no difference seen in median post-operative stay between fibrin sealant versus no treatment (8 versus 9 days, P = 0.327), median total bed cost (£3900 versus £4300, P = 0.400), mean transfusion cost per patient (P = 0.201) and overall cost (£6706.15 versus £6555.80, P = 0.792).
  
  
  CONCLUSIONS
  Fibrin sealant application to cut surface during liver surgery confers no cost benefit and their routine use may not be recommended.
authors: Department of Hepatobiliary and Transplant Surgery, St James University Hospital, Leeds, UK.
authors: Sanjay
authors: S
authors: Pandanaboyana
authors: Department of Hepatobiliary and Transplant Surgery, St James University Hospital, Leeds, UK.
authors: Richard
authors: R
authors: Bell
authors: Department of Hepatobiliary and Transplant Surgery, St James University Hospital, Leeds, UK.
authors: Nehal
authors: N
authors: Shah
authors: Department of Hepatobiliary and Transplant Surgery, St James University Hospital, Leeds, UK.
authors: J Peter A
authors: JPA
authors: Lodge
authors: Department of Hepatobiliary and Transplant Surgery, St James University Hospital, Leeds, UK.
authors: Ernest
authors: E
authors: Hidalgo
authors: Department of Hepatobiliary and Transplant Surgery, St James University Hospital, Leeds, UK.
authors: Giles J
authors: GJ
authors: Toogood
authors: Department of Hepatobiliary and Transplant Surgery, St James University Hospital, Leeds, UK.
authors: K Raj
authors: KR
authors: Prasad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000191:economics; D015179:Colorectal Neoplasms / Q000556:secondary / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Cost-effective; fibrin sealant; hepatectomy; hepatopancreaticobiliary surgery