Observational evaluation of outcomes and resource utilization from hemostatic matrices in spine surgery.
OBJECTIVE
Studies have indicated that outcomes may differ by choice of flowable hemostat, but there is limited evidence in spine surgery. The objective of this study was to conduct a comparison of outcomes following use of advanced flowable hemostatic matrices in a large spine surgery population.


METHODS
This is an observational retrospective cohort analysis using Premier's US Perspective Hospital Database. Two commonly-used hemostatic matrices (Floseal and Surgiflo kitted with thrombin) were compared in cases categorized as either major or severe spine surgery. Outcomes included complications, blood product administration, hospital length of stay (LOS), surgery time, and amount of matrix used in surgery.


RESULTS
Major spine surgery patients treated with Surgiflo were associated with increased risk of blood product transfusion (OR = 2.56, 95% CI = 1.79-3.65, p < 0.001), longer surgery time (+8.84 min, p < 0.0001), and increased product usage (+3.34 mL, p < 0.001), compared to Floseal; however, risk of complications and LOS did not differ by choice of matrix in this patient group. Severe spine surgery patients treated with Surgiflo were associated with longer surgical time (+26.9 min, p < 0.001) and increased product usage (+1.52 mL, p < 0.01), compared to Floseal; however, risk of complications, transfusion and LOS did not differ by choice of matrix in this patient group.


CONCLUSIONS
Inherent to limitations associated with database analysis, this study did not evaluate potential physician differences such as skill and experience, assess long-term outcomes, nor include cases with missing data.


CONCLUSIONS
The results from this analysis indicated that surgery time, risk of blood transfusion, and amount of matrix used are greater with Surgiflo patients, compared to Floseal patients. Choice of matrix did not appear to impact hospital LOS or risk of surgical complications. Future research should evaluate the cost consequences of increased clinical and resource utilization by choice of hemostatic matrix in spine surgery.
a a ProOrtho Clinic , Kirkland , Washington , USA.
J Scott
JS
Price
b b Baxter Healthcare Corporation , Westlake Village , California , USA.
Scott
S
Tackett
c c University of Colorado, School of Medicine , Denver , Colorado , USA.
Vikas
V
Patel
D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000009:adverse effects / Q000627:therapeutic use; D006490:Hemostatics / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D013131:Spine / Q000601:surgery*; D013917:Thrombin / Q000009:adverse effects; D014481:United States / Q000453:epidemiology
C411004:FloSeal Matrix; D006490:Hemostatics; D013917:Thrombin
Bleeding; Hemostatic matrix; Outcomes; Resource utilization; Spine surgery