title: Similar patient outcomes yet different hospital costs between flowable hemostatic agents.
abstract: BACKGROUND
  SURGIFLO and FLOSEAL are absorbable gelatin-based products that form hemostatic matrices. These products are indicated as adjuncts to hemostasis when control of bleeding by conventional surgical techniques (such as suture, ligature or cautery) is ineffective or impractical. This study analyzed the effect of surgery time and the choice of product on cost to the hospital and patient outcomes.
  
  
  METHODS
  The data source was the Premier Hospital database from January 1, 2010-June 30, 2012. Eligible patients were ≥18 years of age with a spinal fusion or refusion surgery with either SURGIFLO (Ethicon Inc.) or FLOSEAL (Baxter International Inc.). The hospital Charge Master was used to identify the amount of flowable product, whether it included Thrombin, and the cost. Multivariable models were performed on overall cost and likelihood of surgical complications. All models were adjusted for patient demographics and severity as well as hospital, and surgical characteristics.
  
  
  RESULTS
  A total of 24,882 patient records from 121 hospitals were analysed, which included 15,088 FLOSEAL records and 9794 SURGIFLO records, with 1498 SURGIFLO with Thrombin patients. Little or no differences in surgical complications were found between surgeries with SURGIFLO vs. surgery with FLOSEAL. Regression models showed a reduction in cost of $65 associated with use of SURGIFLO with Thrombin and an additional $21 reduction in hospital cost for each additional hour of surgery. Modeling which accounts for hospital fixed effects suggest that, in addition to a gap of ∼$300 favoring SURGIFLO with Thrombin, every additional hour of surgery was associated with an additional reduction in hospital costs of ∼$26.
  
  
  CONCLUSIONS
  While the choice of flowable product had no effect on clinical outcomes, use of SURGIFLO was associated with hospital cost savings for flowable product. These savings increased with the length of surgery, even when controlling for the amount of flowable product (mL) used.
authors.affiliation: a a The Wharton School, University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Guy
authors.initials: G
authors.lastname: David
authors.forename: Sangtaeck
authors.initials: S
authors.lastname: Lim
authors.forename: Candace
authors.initials: C
authors.lastname: Gunnarsson
authors.forename: Richard
authors.initials: R
authors.lastname: Kocharian
authors.forename: Sanjoy
authors.initials: S
authors.lastname: Roy
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000191:economics* / Q000627:therapeutic use; D006490:Hemostatics / Q000191:economics* / Q000627:therapeutic use; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012044:Regression Analysis; D013123:Spinal Fusion; D053831:Surgical Fixation Devices; D013917:Thrombin / Q000191:economics* / Q000627:therapeutic use
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics; D013917:Thrombin
keywords: Absorbable gelatins; FLOSEAL; Flowable hemostatic agents; Hospital cost savings; Patient outcomes; SURGIFLO