Variation in hospital resource use and cost among surgical procedures using topical absorbable hemostats

Figures & data

Table 1 Adjunctive hemostat products and classes

Products and categories	Manufacturer
ORCs
Surgicel^® Original	Ethicon, Inc. (Somerville, NJ, USA)
Surgicel Nu-Knit^®	Ethicon, Inc.
Surgicel SNoW™	Ethicon, Inc.
Surgicel Fibrillar^®	Ethicon, Inc.
Surgicel^®, not otherwise specified	Ethicon, Inc.
Flowables
Floseal^®	Baxter Healthcare Corporation (Hayward, CA, USA)
Surgiflo^®	Ethicon, Inc.
Vitasure^®	Stryker Corporation (Malvern, PA, USA)
Flowables, not otherwise specified	Unspecified
Gelatin
Gelfoam^®	Pfizer, Inc. (New York, NY, USA)
Surgifoam^®	Ethicon, Inc.
Gelatin powder	Multiple brands
Gelatin, not otherwise specified	Unspecified
Thrombin
Evithrom^®	Ethicon, Inc.
Recothrom^®	ZymoGenetics, Inc. (Seattle, WA, USA)
Thrombi-Gel^®	Pfizer, Inc.
Thrombi-Pad^®	Pfizer, Inc.
Thrombin, not otherwise specified	Unspecified

Abbreviation: ORCs, oxidized regenerated celluloses.

Figure 1 Distribution of adjunctive hemostat use by type of surgical procedure.

Abbreviations: ORCs, oxidized regenerated celluloses; OAHs, other adjunctive hemostats; CABG, coronary artery bypass grafting; CEA, carotid endarterectomy; Cholecyst, cholecystectomy; Hyster, hysterectomy; Prostat, prostatectomy; AV, arteriovenous.

Table 2 Baseline post-PSM cohort characteristics

	Cardiovascular				Carotid endarterectomy				Cholecystectomy				Hysterectomy
	ORC (n=11,359)		OAH (n=11,359)		ORC (n=5,445)		OAH (n=5,445)		ORC (n=3,045)		OAH (n=3,045)		ORC (n=4,674)		OAH (n=4,674)
	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Age (mean)	65.5	–	64.2	–	70.7	–	70.7	–	59.3	–	59.9	–	49.5	–	49.5	–
Male	7,631	67%	7,935	70%*	3,157	58%	3,110	57%	1,506	49%	1,489	49%	0	0%	0	0%
Ethnicity
Caucasian	8,636	76%	8,760	77%	4,593	84%	4,604	85%	2,151	71%	2,158	71%	3,079	66%	3,046	65%
African American	1,351	12%	1,294	11%	269	5%	268	5%	258	8%	263	9%	840	18%	851	18%
Hispanic	43	<1%	40	<1%	18	<1%	15	<1%	49	2%	45	1%	68	1%	79	2%
Other	1,329	12%	1,265	11%	565	10%	558	10%	587	19%	579	19%	687	15%	698	15%
Comorbidity
Any malignancy	539	5%	523	5%	248	5%	232	4%	347	11%	375	12%	987	21%	938	20%
Metastatic solid tumor	14	<1%	27	<1%*	5	<1%	3	<1%	92	3%	115	4%	272	6%	253	5%
Diabetes	4,610	41%	4,705	41%	1,896	35%	1,939	36%	810	27%	809	27%	518	11%	527	11%
Obesity	2,317	20%	2,345	21%	553	10%	527	10%	650	21%	649	21%	843	18%	839	18%
Cerebrovascular disease	1,228	11%	1,163	10%	5,434	100%	5,433	100%	76	2%	95	3%	29	1%	35	1%
Peripheral vascular	4,275	38%	4,133	36%	1,290	24%	1,365	25%	233	8%	205	7%	27	1%	22	0%
disease
Renal disease	2,725	24%	2,704	24%	642	12%	713	13%*	602	20%	617	20%	139	3%	127	3%
Hypertension	9,023	79%	9,048	80%	4,562	84%	4,541	83%	1,809	59%	1,748	57%	1,545	33%	1,555	33%
Congestive heart failure	3,051	27%	2,972	26%	512	9%	496	9%	319	10%	353	12%	72	2%	60	1%
Myocardial infarction	3,394	30%	3,516	31%	744	14%	683	13%	187	6%	214	7%	55	1%	48	1%
Chronic pulmonary disease	3,453	30%	3,248	29%*	1,347	25%	1,384	25%	566	19%	556	18%	488	10%	483	10%
Pre-existing bleeding conditions
0	7,203	63%	7,147	63%	4,508	83%	4,474	82%	2,100	69%	2,099	69%	3,816	82%	3,861	83%
1	2,423	21%	2,489	22%	663	12%	687	13%	546	18%	537	18%	751	16%	717	15%
2	1,117	10%	1,076	9%	199	4%	197	4%	250	8%	241	8%	78	2%	74	2%
3+	616	5%	647	6%	75	1%	87	2%	149	5%	168	6%	29	1%	22	<1%
Census region
Northeast	2,335	21%	2,013	18%*	561	10%	494	9%*	433	14%	405	13%	824	18%	844	18%
Midwest	1,717	15%	1,772	16%*	1,307	24%	1,233	23%*	769	25%	727	24%	845	18%	860	18%
South	6,148	54%	6,517	57%*	3,044	56%	3,110	57%*	1,140	37%	1,192	39%	2,496	53%	2,461	53%
West	1,159	10%	1,057	9%*	533	10%	608	11%*	703	23%	721	24%	509	11%	509	11%
Bed size
<200	287	3%	287	3%	412	8%	433	8%	522	17%	498	16%*	583	12%	583	12%
200–400	4,657	41%	4,657	41%	2,431	45%	2,388	44%	1,046	34%	1,176	39%*	1,967	42%	2,035	44%
>400	6,415	56%	6,415	56%	2,602	48%	2,624	48%	1,477	49%	1,371	45%*	2,124	45%	2,056	44%
Location
Urban	10,408	92%	10,337	91%	4,534	83%	4,531	83%	2,772	91%	2,735	90%	4,220	90%	4,249	91%
Rural	951	8%	1,022	9%	911	17%	914	17%	273	9%	310	10%	454	10%	425	9%
Affiliation
Teaching	5,902	52%	5,902	52%	2,084	38%	2,167	40%	1,114	37%	1,109	36%	1,920	41%	1,946	42%
Non-teaching	5,457	48%	5,457	48%	3,361	62%	3,278	60%	1,931	63%	1,936	64%	2,754	59%	2,728	58%

Notes:

* P-value <0.05. Presence of statistically significant differences for sex, individual comorbidities, location, and affiliation were determined by z-test; differences for ethnicity, pre-existing bleeding conditions, census region, and bed size were determined by chi-square test.

Abbreviations: ORCs, oxidized regenerated celluloses; OAHs, other adjunctive hemostats; PSM, propensity score matching; n, number of patients.

Figure 2 Hemostat units/discharge and total hemostat cost.

Notes: All differences between OAHs and ORCs for mean units/discharge total hemostat costs (US$) were considered statistically significant at the P<0.001 level. Costs for hemostatic agent classes included all hemostats used.
Abbreviations: ORCs, oxidized regenerated celluloses; OAHs, other adjunctive hemostats.

Table 3 LOS, total procedure cost (US$), transfusion rate, and 30-day readmissions: ORCs compared to OAHs

	Cardiovascular	Carotid endarterectomy	Cholecystectomy	Hysterectomy
LOS
OAHs	9.3	3.0	8.1	3.1
ORCs	9.5	2.7	7.1	3.4
P-value	0.948	<0.001	<0.001	<0.001
Total procedure cost
OAH	$37,784	$11,282	$23,656	$11,033
ORCs	$39,019	$10,580	$20,309	$10,898
P-value	0.003	<0.001	<0.001	0.542
Mortality
OAHs	2%	<1%	3%	<1%
ORCs	2%	<1%	2%	<1%
P-value	0.467	0.654	0.137	0.297
Transfusion rate during hospital stay
OAHs	43%	5%	19%	14%
ORCs	44%	4%	16%	13%
P-value	0.124	<0.001	<0.001	0.303

Abbreviations: ORCs, oxidized regenerated celluloses; OAHs, other adjunctive hemostats; LOS, length of stay.