Price J Scott, Tackett Scott, Patel Vikas
a a ProOrtho Clinic , Kirkland , Washington , USA.
b b Baxter Healthcare Corporation , Westlake Village , California , USA.
J Med Econ. 2015;18(10):777-86. doi: 10.3111/13696998.2015.1046879. Epub 2015 Jun 1.
Studies have indicated that outcomes may differ by choice of flowable hemostat, but there is limited evidence in spine surgery. The objective of this study was to conduct a comparison of outcomes following use of advanced flowable hemostatic matrices in a large spine surgery population.
This is an observational retrospective cohort analysis using Premier's US Perspective Hospital Database. Two commonly-used hemostatic matrices (Floseal and Surgiflo kitted with thrombin) were compared in cases categorized as either major or severe spine surgery. Outcomes included complications, blood product administration, hospital length of stay (LOS), surgery time, and amount of matrix used in surgery.
Major spine surgery patients treated with Surgiflo were associated with increased risk of blood product transfusion (OR = 2.56, 95% CI = 1.79-3.65, p < 0.001), longer surgery time (+8.84 min, p < 0.0001), and increased product usage (+3.34 mL, p < 0.001), compared to Floseal; however, risk of complications and LOS did not differ by choice of matrix in this patient group. Severe spine surgery patients treated with Surgiflo were associated with longer surgical time (+26.9 min, p < 0.001) and increased product usage (+1.52 mL, p < 0.01), compared to Floseal; however, risk of complications, transfusion and LOS did not differ by choice of matrix in this patient group.
Inherent to limitations associated with database analysis, this study did not evaluate potential physician differences such as skill and experience, assess long-term outcomes, nor include cases with missing data.
The results from this analysis indicated that surgery time, risk of blood transfusion, and amount of matrix used are greater with Surgiflo patients, compared to Floseal patients. Choice of matrix did not appear to impact hospital LOS or risk of surgical complications. Future research should evaluate the cost consequences of increased clinical and resource utilization by choice of hemostatic matrix in spine surgery.
研究表明，可流动止血剂的选择可能会导致不同的结果，但脊柱手术方面的证据有限。本研究的目的是在大量脊柱手术人群中比较使用先进的可流动止血基质后的结果。
这是一项使用Premier美国视角医院数据库的观察性回顾性队列分析。在分类为大型或严重脊柱手术的病例中，比较了两种常用的止血基质（Floseal和配备凝血酶的Surgiflo）。结果包括并发症、血液制品使用情况、住院时间（LOS）、手术时间以及手术中使用的基质量。
与Floseal相比，接受Surgiflo治疗的大型脊柱手术患者输血风险增加（OR = 2.56，95% CI = 1.79 - 3.65，p < 0.001），手术时间更长（+8.84分钟，p < 0.0001）且产品使用量增加（+3.34 mL，p < 0.001）；然而，该患者组中并发症风险和住院时间并未因基质选择而有所不同。与Floseal相比，接受Surgiflo治疗的严重脊柱手术患者手术时间更长（+26.9分钟，p < 0.001）且产品使用量增加（+1.52 mL，p < 0.01）；然而，该患者组中并发症、输血风险和住院时间并未因基质选择而有所不同。
由于与数据库分析相关的固有局限性，本研究未评估潜在的医生差异，如技能和经验，未评估长期结果，也未纳入有缺失数据的病例。
该分析结果表明，与使用Floseal的患者相比，使用Surgiflo的患者手术时间、输血风险和基质使用量更大。基质选择似乎并未影响住院时间或手术并发症风险。未来的研究应评估脊柱手术中止血基质选择导致临床和资源利用增加所带来的成本影响。
