title: Health and economic outcomes associated with uncontrolled surgical bleeding: a retrospective analysis of the Premier Perspectives Database.
abstract: BACKGROUND
  Bleeding remains a common occurrence in surgery. Data describing the burden of difficult-to-control bleeding and topical absorbable hemostat use are sparse. This study was conducted to estimate the clinical and economic impact that remains associated with uncontrolled surgical bleeding, even when hemostats are used during surgery.
  
  
  METHODS
  This US retrospective analysis used the Premier Perspectives Database. Hospital discharges from 2012 were used to identify patients treated with hemostats during eight surgery types. Patients were included if they were ≥18 years, had an inpatient hospitalization with one of the eight surgeries, and received a hemostat on the day of surgery. Patients were stratified by procedure and presence or absence of major bleeding (uncontrolled) despite hemostat use. Outcomes were all-cause hospitalization costs, hemostat costs, length of stay, reoperation, and surgery-related complications (eg, mortality). Statistical significance was tested through chi-square or t-tests. Multivariate analyses were conducted for all-cause costs and length of stay using analysis of covariance.
  
  
  RESULTS
  Among 25,048 procedures, major bleeding events occurred in 14,251 cases. Despite treatment with hemostats, major bleeding occurred in 32%-68% of cases. All-cause costs were significantly higher in patients with uncontrolled bleeding despite hemostat use versus controlled bleeding (US$24,203-$61,323 [uncontrolled], US$14,420-$45,593 [controlled]; P<0.001). Hemostat costs were significantly greater in the uncontrolled bleeding cohort for all surgery types except cystectomy and pancreatic surgery. Reoperation and mortality rates were significantly higher in the uncontrolled bleeding cohort in all surgical procedures except cystectomy and radical hysterectomy.
  
  
  CONCLUSIONS
  Uncontrolled intraoperative bleeding despite hemostat use is prevalent and associated with significantly higher hospital costs and worse clinical outcomes across several surgical procedures compared to controlled bleeding. There is an unmet need for newer hemostats that can more effectively control bleeding, improve outcomes, and reduce hospital resource use.
authors.affiliation: Ethicon Biosurgery, Somerville, NJ, USA.
authors.forename: Mitra
authors.initials: M
authors.lastname: Corral
authors.affiliation: Cornerstone Research Group, Burlington, ON, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ferko
authors.affiliation: Cornerstone Research Group, Burlington, ON, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hollmann
authors.affiliation: Partnership for Health Analytic Research, Beverly Hills, CA, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Broder
authors.affiliation: Partnership for Health Analytic Research, Beverly Hills, CA, USA.
authors.forename: Eunice
authors.initials: E
authors.lastname: Chang
keywords: Premier; bleeding; burden; costs; hemostat; surgery