Safety and efficacy of a surgeon-prepared gelatin hemostatic agent compared with FloSeal for hemostasis in laparoscopic partial nephrectomy.

摘要

BACKGROUND AND PURPOSE: Postoperative hemorrhage is a significant risk after laparoscopic partial nephrectomy (LPN). Hemostatic agents have become increasingly popular as adjuncts to renorrhaphy because of their potential to minimize intracorporeal suturing and lessen warm ischemia time. The objective of our study was to compare the safety and efficacy of an inexpensive, surgeon-prepared hemostatic agent with that of a more expensive, commercially prepared one. MATERIALS AND METHODS: Between August 2006 and July 2008, 40 LPNs were performed by a single surgeon at two separate institutions. A commercially available gelatin matrix thrombin, FloSeal, was used at one institution (cohort 1, n=19), while a less expensive, surgeon-prepared gelatin hemostatic agent, Gelfoam, was used at a separate institution (cohort 2, n=21) over the same period. Outcomes, including estimated blood loss (EBL), operative time, transfusion rates, and complications, were compared between the two groups. RESULTS: The median operative and warm ischemia times in cohorts 1 and 2 were 150 (range 132-192) and 16 (range 12-29) minutes and 150 (range 120-300) and 20 (range 14-37) minutes, respectively (P = 0.16, 0.07). The median EBL was 150 mL (range 50-250) and 100 mL (range 50-1000) (P = 0.09), and the postoperative transfusion rate was 0% and 4.8% (P = 0.33). Median LOS was 2 (range 2-7) and 3 (range 2-7) days (P = 0.62). Potential cost saved per case was Dollars 200 to Dollars 450. CONCLUSION: As health care costs continue to rise, delivering high-quality care in a cost-effective manner is paramount. Our study demonstrates similar safety and efficacy of a surgeon-prepared, cheaper gelatin matrix compared with FloSeal. Generic hemostatic agents are a viable alternative to more expensive agents in institutions in which commercially available agents are not available or cost prohibitive.