Observational evaluation of outcomes and resource utilization from hemostatic matrices in spine surgery

Abstract

Objective:

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.

Methods:

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.

Results:

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.

Limitations:

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.

Conclusion:

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.

Keywords::

• Spine surgery
• Outcomes
• Resource utilization
• Hemostatic matrix
• Bleeding

View addendum:

Price JS, Tackett S, Patel V. Observational evaluation of outcomes and resource utilization from hemostatic matrices in spine surgery. J Med Econ 2015; 1-10.

Transparency

Declaration of funding

This study was funded by Baxter Healthcare Corporation. Baxter purchases data rights to Premier’s US Perspective Hospital Database.

Declaration of financial/other relationships

ST is an employee of Baxter Healthcare Corporation. A JME peer reviewer on this manuscript was an investigator on a cited trial.

Acknowledgments

We thank Therese Conner, PhD, for her manuscript writing assistance, Deborah Testa, PhD, for her contribution to dataset development, and Marc Rubinstein, MD, Michelle Reed Arnold, MD, Steve Czop, RPh, Diane Ito, MA, and Yan Xiong, MS, for their technical expertise and contributions.