title: Improvement of Perioperative Outcomes in Major Gynecological and Gynecologic-Oncological Surgery with Hemostatic Gelatin-Thrombin Matrix.
abstract: To assess the impact of the use of intraoperative hemostatic gelatin-thrombin matrix (HM) (Floseal®, Baxter Healthcare) on transfusion rates and short-term perioperative outcomes in gynecological surgery.
  
  
  
  In this retrospective, single-center study, we evaluated data of 215 patients (83 cases and 132 controls) undergoing extensive gynecological surgery (e.g. oncological procedures) with and without intraoperative HM application.
  
  
  
  Cases and controls did not differ according to age, preoperative hemoglobin (Hb) concentration, and Hb or C-reactive protein (CRP) levels at discharge. Patients receiving HM had significantly reduced operative (168 vs. 199 min, p=0.02) and hospitalization (9 vs. 14 days, p<0.001) times. The mean postoperative Hb drop (3.33 vs. 4.51 g/dl, p<0.001), and the mean postoperative increase in CRP (94.9 vs. 149.1 mg/l, p<0.001) were significantly less pronounced within the HM group. Despite more prevalent coagulopathy (48 vs. 31%, p=0.02), e.g. due to anticoagulant use (15.7 vs. 3%, p<0.001), patients treated using HM needed less frequent transfusions of packed red blood cells [odds ratio (OR)= 0.13, 95% confidence interval (CI)=0.07-0.24) and fresh frozen plasma (OR=0.51, 95% CI=0.24-1.05). In comparison to controls, the need for surgical revisions (OR 0.1, CI 95% 0.02-0.42) and intensive-care unit admissions (OR 0.15, 95% CI=0.08-0.30) was lower in patients treated with HM.
  
  
  
  To our knowledge, our study is the largest case-control study focusing on Floseal® use in gynecology. The use of HM was associated with significantly better short-term perioperative outcomes. Due to its local action, HM seems to be particularly useful in patients in which anticoagulant medication cannot be paused.
authors.affiliation: Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany Rafal.Watrowski@gmx.at.
authors.forename: Rafał
authors.initials: R
authors.lastname: Watrowski
authors.affiliation: Department of Gynecology and Obstetrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Jäger
authors.affiliation: Department of Pediatrics, St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Forster
mesh_terms: D000328:Adult; D000368:Aged; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D016063:Blood Loss, Surgical / Q000517:prevention & control; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D059035:Perioperative Period; D010949:Plasma; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics
keywords: Floseal®; Gynecologic surgery; hemostasis; hemostatic matrix; intraoperative bleeding