title: The effect of TISSEEL fibrin sealant on seroma formation following complex abdominal wall hernia repair: a single institutional review and derived cost analysis.
abstract: OBJECTIVE
  The authors evaluated the ability of a fibrin sealant (TISSEEL™: Baxter Healthcare Corp, Deerfield, IL, USA) to reduce the incidence of post-operative seroma following abdominal wall hernia repair.
  
  
  METHODS
  We performed a 4-year retrospective review of patients undergoing abdominal wall hernia repair, with and without TISSEEL, by a single surgeon (FEE) at The Johns Hopkins Hospital. Demographics, surgical risk factors, operative data and 30-day outcomes, including wound complications and related interventions, were compared. The quantity and cost of Tisseel per case was reviewed.
  
  
  RESULTS
  A total of 250 patients were evaluated: 127 in the TISSEEL group and 123 in the non-TISSEEL control group. The average age for both groups was 56.6 years (P = 0.97). The majority of patients were female (TISSEEL 52.8%, non-TISSEEL 56.1%, P = 0.59) and ASA Class III (TISSEEL 56.7%, non-TISSEEL 58.5%, P = 0.40). There was no difference in the average defect size for both groups (TISSEEL 217 ± 187.6 cm(2), non-TISSEEL 161.3 ± 141.5 cm(2), P = 0.36). Surgical site occurrences occurred in 18.1% of the TISSEEL and 13% of the non-TISSEEL group (P = 0.27). There was a trend towards an increased incidence of seroma in the TISSEEL group (TISSEEL 11%, non-TISSEEL 4.9%, P = 0.07). A total of $124,472.50 was spent on TISSEEL, at an average cost of $995.78 per case.
  
  
  CONCLUSIONS
  In the largest study to date, TISSEEL™ application offered no advantage for the reduction of post-operative seroma formation following complex abdominal hernia repair. Moreover, the use of this sealant was associated with significant costs.
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA. sazoury1@jhmi.edu.
authors.forename: S C
authors.identifier: http://orcid.org/0000-0002-2263-4149
authors.initials: SC
authors.lastname: Azoury
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: N
authors.initials: N
authors.lastname: Rodriguez-Unda
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Soares
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: Hicks
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Baltodano
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors.forename: K E
authors.initials: KE
authors.lastname: Poruk
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Q L
authors.initials: QL
authors.lastname: Hu
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Cooney
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors.forename: P
authors.initials: P
authors.lastname: Cornell
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA.
authors.forename: K
authors.initials: K
authors.lastname: Burce
authors.affiliation: Department of Surgery, The Johns Hopkins Hospital, Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, Blalock 618, Baltimore, MD, 21287, USA. feckhau2@jhmi.edu.
authors.forename: F E
authors.initials: FE
authors.lastname: Eckhauser
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000191:economics / Q000627:therapeutic use*; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*; D014945:Wound Healing
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Abdominal wall; Fibrin sealant; Hernia; Seroma; TISSEEL