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UPJ INSIGHT Trends, Cost, and Predictors of Local Hemostatics Use in Major Urological Surgery
By: Camilo Arenas-Gallo, MD, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Ohio; Patrick Lewicki, MD, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York; Megan Prunty, MD, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Ohio; Aaron Brant, MD, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York; Stephen Rhodes, PhD, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Ohio; Spyridon P. Basourakos, MD, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York; Alec Zhu, MD, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York; Bashir Al Hussein Al Awamlh, MD, Vanderbilt University Medical Center, Nashville, Tennessee; Jonathan E. Shoag, MD, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Ohio, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York | Posted on: 27 Nov 2023
Arenas-Gallo C, Lewicki P, Prunty M, et al. Trends, cost and predictors of local hemostatics use in major urological surgery. Urol Pract. 2023;10(6):568-578.
Study Need and Importance
The national use of topical hemostatic agents in major urologic procedures has not been extensively evaluated. This study describes the trends, costs, and predictors of hemostatic agent use, providing critical information for cost-effective patient care, resource allocation, and identifying regional and hospital differences in patient care.
What We Found
We identified a total of 13 different agents, with an average of 1.38 agents used per procedure. Absorbable hemostat (Surgicel) was the most frequently used hemostatic agent. The use of hemostatic agents increased significantly between 2000 and 2010, and then remained stable for the next decade (Figure). The cost of hemostatic agent use was relatively small compared to the total hospitalization cost and did not significantly differ between open and laparoscopic/robotic approaches. The use of these agents was correlated by patient, surgeon, and hospital characteristics.
Limitations
Some limitations included the lack of detailed information in the Premier Healthcare Database regarding surgical indications, tumor characteristics, use of anticoagulants, surgical complexity, and blood loss. It was beyond the scope of the analysis to explore the relationship between hemostatic use, clinical outcomes, and risk of bleeding.
Interpretation for Patient Care
Despite the specific cost of hemostatics being a factor, it does not appear to significantly increase the total hospitalization cost. Moreover, no significant differences were noted between open and laparoscopic/robotic approaches. Surgeons may continue to use hemostatic agents due to their wide availability, low cost relative to the total cost of the procedure, and perceived benefits in highly vascular surgical sites. However, the impact of these agents on surgical outcomes and bleeding risk remains to be clarified.
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