title: Gelatin-thrombin hemostatic matrix in neurosurgical procedures: hemostatic effectiveness and economic value of clinical and surgical procedure-related benefits.
abstract: BACKGROUND
  Gelatin-thrombin hemostatic matrix (FloSeal®) use is associated with shorter surgical times and less blood loss, parameters that are highly valued in neurosurgical procedures. We aimed to assess the effectiveness of gelatin-thrombin in neurosurgical procedures and estimate its economic value.
  
  
  METHODS
  In a 6-month retrospective evaluation at 2 hospitals, intraoperative and postoperative information were collected from patients undergoing neurosurgical procedures where bleeding was controlled with gelatin-thrombin matrix or according to local bleeding control guidelines (control group). Study endpoints were: length of surgery, estimated blood loss, hospitalization duration, blood units utilized, intensive care unit days, postoperative complications, and time to recovery. Statistical methods compared endpoints between the gelatin-thrombin and control groups and resource utilization costs were estimated.
  
  
  RESULTS
  Seventy-eight patients (38 gelatin-thrombin; 40 control) were included. Gelatin-thrombin was associated with a shorter surgery duration than control (166±40 versus 185±55 minutes, P=0.0839); a lower estimated blood loss (185±80 versus 250±95 mL; P=0.0017); a shorter hospital stay (10±3 versus 13±3 days; P<0.001); fewer intensive care unit days (10 days/3 patients and 20 days/4 patients); and shorter time to recovery (3±2.2 versus 4±2.8 weeks; P=0.0861). Fewer gelatin-thrombin patients experienced postoperative complications (3 minor) than the control group (5 minor; 3 major). No gelatin-thrombin patient required blood transfusion; 5 units were administered in the control group. The cost of gelatin-thrombin (€ 268.40/unit) was offset by the shorter surgery duration (difference of 19 minutes at € 858/hour) and the economic value of improved the other endpoint outcomes (i.e., shorter hospital stay, lesser blood loss/lack of need for transfusion, fewer intensive care unit days, and complications).
  
  
  CONCLUSIONS
  The use of gelatin-thrombin hemostatic matrix in patients undergoing neurosurgical procedures was associated with better intra- and postoperative parameters than conventional hemostasis methods, with these parameters having substantial economic benefits.
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy - felice.esposito@unime.it.
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.affiliation: Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Filippo F
authors.initials: FF
authors.lastname: Angileri
authors.affiliation: Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Cavallo
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Stefano M
authors.initials: SM
authors.lastname: Priola
authors.affiliation: Division of Maxillo-Facial Surgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Crimi
authors.affiliation: Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Solari
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Antonino F
authors.initials: AF
authors.lastname: Germanò
authors.affiliation: Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomasello
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000191:economics; D005260:Female; D005780:Gelatin / Q000097:blood*; D006490:Hemostatics / Q000097:blood* / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications; D013917:Thrombin / Q000378:metabolism*; D013997:Time Factors
chemical_list: D006490:Hemostatics; D005780:Gelatin; D013917:Thrombin