Length of stay and hospitalization costs for patients undergoing lung surgery with Progel pleural air leak sealant

Abstract

Aim: Progel Pleural Air Leak Sealant (Progel) is currently the only sealant approved by the FDA for the treatment of air leaks during lung surgery. This study was performed to determine whether Progel use improves hospital length of stay (LOS) and hospitalization costs compared with other synthetic/fibrin sealants in patients undergoing lung surgery.

Methods: The US Premier hospital database was used to identify lung surgery discharges from January 1, 2010 to June 30, 2015. Eligible discharges were categorized as “Progel Sealant” or “other sealants” using hospital billing data. Propensity score matching (PSM) was performed to control for hospital and patient differences between study groups. Primary outcomes were hospital LOS and all-cause hospitalization costs. Clinical outcomes, hospital re-admissions, and sealant product use were also described.

Results: After PSM, a total of 2,670 discharges were included in each study group; baseline characteristics were balanced between groups. The hospital LOS (mean days ± standard deviation, median) was significantly shorter for the Progel group (9.9 ± 9.6, 7.0) compared with the other sealants group (11.3 ± 12.8, 8.0; p < .001). Patients receiving Progel incurred significantly lower all-cause hospitalization costs ($31,954 ± $29,696, $23,904) compared with patients receiving other sealants ($36,147 ± $42,888, $24,702; p < .001).

Limitations: It is not possible to say that sealant type alone was responsible for the findings of this study, and analysis was restricted to the data available in the Premier database.

Conclusions: Among hospital discharges for lung surgery, Progel use was associated with significantly shorter hospital LOS and lower hospitalization costs compared with other synthetic/fibrin sealants, without compromising clinical outcomes.

Keywords:

• Pleural air leak
• surgery complications
• database
• health economics
• outcomes

JEL classification codes:

• I10
• O30

Transparency

Declaration of funding

Funding was provided by Davol Inc., a subsidiary of C. R. Bard. Bard has joined BD.

Declaration of financial/other relationships

KDM is a paid consultant for Becton Dickinson. Cornerstone Research Group (IS, NF) received funding from Becton Dickinson to conduct the study. MC, XZ, and IB are employees of Becton Dickinson. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

This research was presented at the ISPOR 19th Annual European Congress, Vienna, Austria, October 30–November 2, 2016, and the 30th Annual Meeting of the General Thoracic Surgical Club, Clearwater, Florida, March 9–12, 2017.

Acknowledgments

The authors would like to acknowledge Ying Wan for assisting in study design and results interpretation, and Lisa Bernard for assisting with drafting of the manuscript.