Perioperative outcomes and hospital costs associated with flowable gelatin hemostatic matrix for lumbar surgeries in real world hospital setting

Figures & data

Table 1. Summary of patient baseline characteristics (before and after propensity score match and PLIF sub-group).

Variables	Before matching		After matching		PLIF sub-groups
	FGHM group (n = 108)	HC group (n = 82)	FGHM group (n = 64)	HC group (n = 64)	FGHM group (n = 93)	HC group (n = 79)
Demographics
Age (years)	55.7 ± 16.7	55.5 ± 13.3	58.0 ± 16.2	55.0 ± 14.2	57.3 ± 16.3	55.6 ± 13.1
Male (%)	54.6	53.7	57.8	54.7	51.6	54.4
BMI (kg/m^2)	25.6 ± 3.4	26.1 ± 3.7	26.1 + 3.7	25.9 ± 3.8	25.8 ± 3.4	26.2 ± 3.7
Smoking (%)	24.1	15.9	23.4	15.6	24.7	16.5
Drinking (%)	21.3	22	25	15.6	23.7	21.5
Health insurance plan (%)
Out-of-pocket	83.3	73.2	81.3	73.4	80.6	74.7
Local public health insurance	13	20.7	12.5	23.4	15.1	19.0
Medical insurance for civil servant	1.9	1.2	3.1	1.6	2.2	1.3
Military health insurance	1.9	1.2	3.1	1.6	2.2	1.3
New rural cooperative medical insurance	0	3.7	0	0	0.0	3.8
Employment
Retired	45.4	40.2	48.4	43.8	48.39	40.51
Full time employment	25.9	28	29.7	34.4	24.73	26.58
Unemployed*	14.8	4.9	3.1	3.1	12.90	5.06
Farmer*†	11.1	24.4	15.6	15.6	11.83	25.32
Student	2.8	2.4	3.1	3.1	2.15	2.53
Residence (%)
Beijing	25.9	26.8	28.1	26.6	29.03	25.32
Provincial capital city	2.8	3.7	1.6	4.7	3.23	3.80
Regional city*†	40.7	24.4	31.3	31.3	38.71	24.05
County town	15.7	13.4	15.6	15.6	13.98	13.92
Rural area*†	13.9	31.7	21.9	21.9	15.05	32.91
Other	0.9	0	1.6	0	0	0
Operation indications (%)
Disc herniation	6.5	9.8	3.1	12.5	7.5	10.1
Canal stenosis	9.3	13.4	10.9	12.5	10.8	13.9
Spondylolisthesis	27.8	40.2	28.1	39.1	31.2	39.2
Disc herniation + canal stenosis	38.9	25.6	37.5	26.6	32.3	25.3
Canal stenosis + spondylolisthesis	13.9	8.5	18.8	7.8	15.1	8.9
Disc herniation + spondylolisthesis	1.9	1.2	1.6	0	1.1	1.3
Disc herniation + Lumbar canal stenosis + spondylolisthesis	1.9	1.2	0	1.6	2.2	1.3
anti-platelet/coagulants agents (%)	3.7	0	4.7	0	3.2	0
Patients with normal laboratory tests (%)
INR	96.2	92.7	92.2	93.8	95.6	92.4
Hemoglobin	95.4	90.2	96.9	90.6	95.7	89.9
Platelet	93.5	86.6	93.8	87.5	92.5	86.1
Erythrocytes	99.1	98.8	100	98.4	98.9	98.7
White blood cell	93.5	93.9	92.2	95.3	94.6	93.7
Surgical values (%)
MIS-TLIF*	13.9	3.7	4.7	4.7	0	0
PLIF*	86.1	96.3	95.3	95.3	100	100
L2 + L3	0	1.2	0	1.6	0	1.3
L3 + L4	0	1.2	0	1.6	0	0
L4 + L5	36.1	31.7	37.5	32.8	32.3	32.9
L5 + S1	14.8	9.8	9.4	12.5	11.8	7.6
L4 + L5 + S1	24.1	20.7	29.7	21.9	26.9	21.5
L3 + L4 + L5	13.9	23.2	12.5	21.9	16.1	24.1
L3 + L4 + L5 + S1	5.6	7.3	3.1	6.3	6.5	7.6
L2 + L3 + L4 + L5	0	1.2	0	0	0	1.3
L2 + L3 + L4 + L5 + S1	1.9	0	1.6	0	2.2	0
T10 + T11 + T12 + L1 + L2 + L3	0.9	0	1.6	0	1.1	0
T10 + T11 + T12 + L1 + L2 + L3 + L4 + L5	1.9	2.4	3.1	0	2.2	2.5
T10 + T11 + T12 + L1 + L2 + L3 + L4 + L5 + S1	0.9	0	1.6	0	1.1	0
T6 + T7 + T8 + T9 + T10 + T11 + T12 + L1 + L2 + L3 + L4 + L5	0	1.2	0	1.6	0	1.3
No. of fusion CAGE	1.6 ± 0.7	1.7 ± 0.7	1.6 ± 0.8	1.6 ± 0.7	1.7 ± 0.8	1.7 ± 0.7
No. of utilized spinal screw	5.6 ± 2.6	5.7 ± 2.9	5.8 ± 3.0	5.4 ± 2.7	5.8 ± 2.7	5.8 ± 3.0

*p < 0.05 in comparisons of original groups.

†p < 0.05 in comparisons of PLIF groups.

Abbreviations. BMI, body mass index; FGHM, flowable gelatin hemostatic matrix; HC, historical control; INR, international normalized ratio; MIS-TLIF, minimally invasive surgeries of transforaminal lumbar interbody fusion; PLIF, posterior spinal fusion.

Table 2. The summary of the measured surgical outcomes and total cost (before propensity score match and PLIF sub-group).

Outcomes	Original groups			PLIF sub-groups
	FGHM group (n = 108)	HC group (n = 82)	p-value	FGHM group (n = 93)	HC group (n = 79)	p-value
Blood loss (mL)	281.5 ± 191.2	303.7 ± 243.8	0.483	300.5 ± 197.1	311.4 ± 245.1	0.748
Total transfusion rate (%)	33.3	68.3	<0.001	38.7	70.9	<0.001
Allogeneic transfusion rate (%)	23.1	53.7	<0.001	26.9	55.7	<0.001
Total transfusion volume (mL)	182.7 ± 312.9	329.8 ± 286.3	0.001	212.2 ± 328.0	342.3 ± 284.2	0.006
Allogeneic transfusion volume (mL)	148.5 ± 300.5	270.6 ± 299.6	0.006	172.5 ± 317.5	280.9 ± 300.8	0.023
Drainage tube placement (%)	76.9	95.1	<0.001	89.2	98.7	0.012
Duration of placed drainage tube (days)	3.0 ± 2.1	3.5 ± 1.2	0.046	3.5 ± 1.9	3.6 ± 1.0	0.461
Total drain output (mL)	480.9 ± 417.6	518.0 ± 353.7	0.519	558.5 ± 398.8	537.6 ± 345.2	0.717
Operation time (min)	219.8 ± 64.6	208.8 ± 59.8	0.231	223.1 ± 65.3	210.5 ± 60.2	0.192
Post-operative LOS (days)	6.4 ± 3.6	6.6 ± 1.9	0.631	6.7 ± 3.7	6.7 ± 1.9	0.974
Post-operative antibiotics (days)	6.3 ± 3.3	7.0 ± 2.5	0.148	6.6 ± 3.4	7.1 ± 2.5	0.365
Flowable gelatin (kit)	1.3 ± 0.5	0	<0.001	1.4 ± 0.6	0	0.001
Total hospital cost (medium, Q1–Q3)	85,991 (62,571–100,440)	83,421 (65,347–109,010)	0.667	87,885 (67,467–109,798)	85,899 (69,110–110,377)	0.823

Table 3. The summary of the measured surgical outcomes and total cost (after propensity score match).

	Matched groups
Outcomes	FGHM group (n = 64)	HC group (n = 64)	p-value
Blood loss (mL)	297.7 ± 206.3	281.3 ± 235.1	0.690
Total transfusion rate (%)	34.4	64.1	0.005
Allogeneic transfusion rate (%)	25.0	54.7	0.004
Total transfusion volume (mL)	182.7 ± 312.4	301.3 ± 281.0	0.045
Allogeneic transfusion volume (mL)	150.0 ± 294.8	267.0 ± 290.4	0.043
Drainage tube placement (%)	82.8	93.8	0.046
Duration of placed drainage tube (days)	3.0 ± 1.9	3.4 ± 1.2	0.208
Total drain output (mL)	493.2 ± 348.6	478.1 ± 344.7	0.803
Operation time (min)	225.1 ± 67.7	203.9 ± 55.2	0.063
Post-operative LOS (days)	5.9 ± 1.9	6.5 ± 2.1	0.093
Post-operative antibiotics (days)	6.0 ± 2.6	7.1 ± 2.4	0.010
Flowable gelatin (kit)	1.3 ± 0.6	0	<0.001
Total hospital cost (medium, Q1–Q3)	87,707 (68,597–97,993)	84,735 (64,344–108,590)	0.949

Abbreviations. FGHM, flowable gelatin hemostatic matrix; HC, historical control; LOS, length of stay; PLIF, posterior spinal fusion.

Figure 1. Multiple generalized linear regression analysis assessing the impact of flowable gelatin hemostatic matrix on the total hospitalization costs (n = 190).