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Surgical bleeding can adversely affect patient outcomes, hospital costs and resources
Up to 68% of cases in open procedures experience disruptive bleeding events despite the use of haemostats1
Challenging and uncontrollable bleeding during surgery is associated with increased mortality rates1,2
Complications related to surgical bleeding may increase resource utilization3-7
Compared to primary methods of hemostasis alone, adjunctive hemostats have been associated with reduced use of hospital resources in the following ways:
Up to 35% fewer patients require blood transfusions8-13
Up to 4 days shorter length of hospital stay8-15
Up to 25 minutes reduced operating time14-15
Clarifying the Confusion16
An Ethicon study found that, when confronted with bleeding, surgeons consider the site and the situation as the primary factors in choosing which adjunctive haemostat to use. From the study and based on surgeon input, five categories emerged to describe the bleeding situations that surgeons encounter. These five bleeding situations are:
- Continuous oozing
- Problematic bleeding
- Difficult-to-access bleeding
- Potential re-bleeding risk
- High-pressure vessel bleeding16
Continuous Oozing
Continuous oozing will not stop with compression/ simple packing, thus the solution for this bleeding is more time consuming than it is difficult.16
Continuous Oozing: Oxidized Regenerated Cellulose:
An absorbable plant-based biomaterial that expedites the haemostasis process by serving as a scaffold for platelet adhesion and aggregation to assist with clot formation.16
The Surgicel Family of absorbable haemostats has over 50+ years of clinical
performance with an established safety and efficacy profile.17-18
Problematic Bleeding
Problematic:
Even though the bleeding is accessible, it could be trouble. It is more than routine, likely to be resistant to conventional means, requires immediate attention, and causes disruption to the normal progression of surgery.16
Problematic: Fibrin Patch:
Fibrinogen and thrombin patch provides mechanical integrity and supports clot formation independent of the patient coagulation profile for problematic bleeding in indicated patients.16
Difficult-to-Access Bleeding
Bleeding that occurs in tight and irregular spaces; you cannot see the exact source of the bleed. You are concerned that accessing a tight space will cause more harm.16
Difficult to Access: Flowable Gelatin: A gelatin-based foam that flows into the bleeding area and serves as a scaffold for platelet adhesion and can be combined with thrombin to expedite clot formation.16
Potential Re-Bleeding
Bleeding may be addressed intra-operatively but could later develop into more serious complications, especially in high-risk patients.16
Potential Re-bleeding Risk: Fibrin Sealant: Fibrinogen and thrombin, when mixed, create a fibrin clot independent of the patient coagulation profile.16,19
High-Pressure Vessel Bleeding
High-Pressure Vessel Bleeding:
A leak in a high-pressure vessel (aortic peripheral vascular suture line) that has been stopped, but if it leaks post-op, could be catastrophic.16
High-Pressure Vessel Bleeding: Vascular Sealant:
A surgical adhesive that secures suture lines and provides a mechanical seal.16
Commit
Haemostasis Optimisation Program (HOP) is a partnership program that is designed to improve utilization of adjunctive haemostats through a systematic approach that will:
- Evaluate product Use
- Educate Surgical teams
- Provide recommendations for product use
HOP demonstrated in a real-world setting that it can help hospitals achieve substantial cost savings by shifting to a more cost-effective use of haemostats— without sacrificing effectiveness or affecting patient outcomes.16
The hospital in which the HOP research was conducted in 2016-2017, saw a 15% reduction in spending per hemostat unit over the course of a year. The annual cost savings to the hospital exceeded $168,000.16
References
*Compared to primary methods of hemostasis alone (117999-190704 EMEA)
1. Corral, Health and economic outcomes associated with uncontrolled surgical bleeding: a retrospective analysis of the Premier Perspectives Database, Clinico Economics and Outcomes Research;2015;7;409
2. Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G. Pathophysiology of bleeding in surgery.2006; Transplant Proc 38 (3):812-814
3. Stokes, Impact of bleeding-related complications and or blood product transfusions on hospital costs in inpatient surgical patients, BMC Health Services Res;2011;11;135
4. Kahn, Cost Savings Attributable to Reductions in Intensive Care Unit Length of Stay for Mechanically Ventilated Patients, Med Care;2008;46;1226
5. Dasta, Daily cost of an intensive care unit day The contribution of mechanical ventilation, Crit Care_Med;2005;33;1266
6. Toner, Costs to Hospitals of Acquiring and Processing Blood in the US A Survey of Hospital-Based Blood Banks and Transfusion Services, Appl Health Econ Health Policy;2011;9;29
7. Al-Attar,Impact of bleeding complications on length of stay and critical care utilization in cardiac surgery patients in England,Journal of Cardiothoracic Surgery;2019;14;64
8. Notarnicola A, Moretti L, Martucci A, Spinarelli A, Tafuri S, Pesce V, Moretti B. Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty. Blood Coagul Fibrinolysis. 2012; 23 (4):278-284
9. Molloy DO, Archbold HA, Ogonda L, McConway J, Wilson RK, Beverland DE. Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial. J Bone Joint Surg
Br. 2007; 89 (3):306-309.
10. Sabatini L, Trecci A, Imarisio D, Uslenghi MD, Bianco G, Scagnelli R. Fibrin tissue adhesive reduces postoperative blood loss in total knee arthroplasty. J Orthop Traumatol. 2012; 13 (3):145-151.
11. Wang GJ, Hungerford DS, Savory CG, Rosenberg AG, Mont MA, Burks SG, Mayers SL, Spotnitz WD. Use of fibrin sealant to reduce bloody drainage and hemoglobin loss after total knee arthroplasty: a brief note on a randomized
prospective trial. J Bone Joint Surg. 2001. 83-A (10):1503-1505.
12. Randelli F, Banci L, Ragone V, Pavesi M, Randelli G. Efectiveness of fibrin sealant after cementless total hip replacement: a double-blind randomized controlled trial. Int J Immunopathol Pharmacol. 2013; 26 (1):189-197.
13. Joseph T, Adeosun A, Paes T, Bahal V. Randomised controlled trial to evaluate the efficacy of TachoComb H Patches in Controllin PTFE Suture-hole Bleeding. Eur J Vasc Endovasc Surg. 2004; 27, 549-552.
14. Pan HW, Zhong JX, Jing CX. Comparison of fibrin glue versus suture for conjunctival autografting in pterygium surgery: a meta-analysis. Ophthalmology. 2011; 118 (6):1049-1054.
15. Dancey AL, Cheema M, Thomas SS (2010) A prospective randomized trial of the efficacy of marginal quilting sutures and fibrin sealant in reducing the incidence of seromas in the extended latissimus dorsi donor site. Plast Reconstr Surg
125 (5):1309-1317.
16. Ferko N, Danker W, Gangoli G. A systematic approach to surgical hemostat use supports standardization and cost efficiencies. Healthcare Purchasing News. 2017; 41 (11):34-35.
17. Hong YM, Loughlin KR. The use of haemostatic agents and sealants in urology. J Urol. 2006;176 (6 Pt 1):2367-2374
18. Ethicon, 20110131 IMS Hospital Supply Index Ethicon US BIOSURGERY Hospital, Jan 2011, Data on File.
19. Spotnitz, Fibrin Sealant Patches; powerful and easy-to use hemostats.Open Access Surgery,2014. 71-79