title: Variation in hospital resource use and cost among surgical procedures using topical absorbable hemostats.
abstract: BACKGROUND
  Adjunctive hemostats are used to assist with the control of intraoperative bleeding. The most common types are flowables, gelatins, thrombins, and oxidized regenerated celluloses (ORCs). In the US, Surgicel(®) products are the only US Food and Drug Administration-approved ORCs.
  
  
  OBJECTIVE
  To compare the outcomes of health care resource utilization (HRU) and costs associated with using ORCs compared to other adjunctive hemostats (OAHs are defined as flowables, gelatins, and topical thrombins) for surgical procedures in the US inpatient setting.
  
  
  METHODS
  A retrospective, US-based cohort study was conducted using hospital inpatient discharges from the 2011-2012 calendar years in the Premier Healthcare Database. Patients with either an ORC or an OAH who underwent a cardiovascular procedure (valve surgery and/or coronary artery bypass graft surgery), carotid endarterectomy, cholecystectomy, or hysterectomy were included. Propensity score matching was used to create comparable groups of ORC and OAH patients. Clinical, economic, and HRU outcomes were compared.
  
  
  RESULTS
  The propensity score matching created balanced patient cohorts for cardiovascular procedure (22,718 patients), carotid endarterectomy (10,890 patients), cholecystectomy (6,090 patients), and hysterectomy (9,348 patients). In all procedures, hemostatic agent costs were 28%-56% lower for ORCs, and mean hemostat units per discharge were 16%-41% lower for ORCs compared to OAHs. Length of stay and total procedure costs for patients treated with ORCs were lower for carotid endarterectomy patients (0.3 days and US$700) and for cholecystectomy patients (1 day and US$3,350) (all P<0.001).
  
  
  CONCLUSIONS
  Costs and HRU for patients treated with ORCs were lower than or similar to patients treated with OAHs. Proper selection of the appropriate hemostatic agents has the potential to influence clinical outcomes and treatment costs.
authors.affiliation: Trinity Partners, LLC, Waltham, MA, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Martyn
authors.affiliation: Trinity Partners, LLC, Waltham, MA, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Meckley
authors.affiliation: Trinity Partners, LLC, Waltham, MA, USA.
authors.forename: Gavin
authors.initials: G
authors.lastname: Miyasato
authors.affiliation: Global Health Economics and Market Access, Ethicon, Inc., Bridgewater, NJ, USA.
authors.forename: Sangtaeck
authors.initials: S
authors.lastname: Lim
authors.affiliation: Medical Affairs, Ethicon, Inc., Bridgewater, NJ, USA.
authors.forename: Jerome B
authors.initials: JB
authors.lastname: Riebman
authors.affiliation: Medical Affairs, Ethicon, Inc., Bridgewater, NJ, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Kocharian
authors.affiliation: Trinity Partners, LLC, Waltham, MA, USA.
authors.forename: Jillian G
authors.initials: JG
authors.lastname: Scaife
authors.affiliation: Trinity Partners, LLC, Waltham, MA, USA.
authors.forename: Yajing
authors.initials: Y
authors.lastname: Rao
authors.affiliation: Global Health Economics and Market Access, Ethicon, Inc., Bridgewater, NJ, USA.
authors.forename: Mitra
authors.initials: M
authors.lastname: Corral
keywords: blood transfusion; health care costs; hemostatic techniques; hemostatics; surgical blood loss