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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2016 Jul 26


language: English

Gelatin-thrombin hemostatic matrix in neurosurgical procedures: hemostasis effectiveness and economic value of clinical and surgical procedure-related benefits

Felice ESPOSITO 1, Paolo CAPPABIANCA 2, Filippo F. ANGILERI 1, Luigi M. CAVALLO 2, Stefano M. PRIOLA 1, Salvatore CRIMI 3, Domenico SOLARI 2, Antonino F. GERMANÒ 1, Francesco TOMASELLO 1

1 Università degli Studi di Messina, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Division of Neurosurgery, Messina, Italy; 2 Università degli Studi di Napoli Federico II, Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Naples, Italy; 3 Università degli Studi di Messina, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Division of Maxillo-Facial Surgery, Messina, Italy


OBJECTIVES: 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.
PATIENTS AND 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=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 per hour) and the economic value of improved the other endpoint outcomes (ie, shorter hospital stay, less blood loss/lack of need for transfusion, fewer intensive care unit days, and complications).
CONCLUSION: Gelatin-thrombin hemostatic matrix use in patients undergoing neurosurgical procedures was associated with better intra- and post-operative parameters than conventional hemostasis methods, with these parameters having substantial economic benefits.

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