[Topical haemostatic agents in neurosurgery].

Haemostasis is of fundamental significance in neurosurgery, and insufficient control of bleeding is associated with morbidity and mortality. Topical haemostatic agents play an important role, as the characteristics of neuronal tissue limit the use of classical surgical haemostasis techniques. Appropriate choice of agent depends on the location and type of bleeding, but also on knowledge of the products' mechanisms of action, indications, price and accessibility. Biological products are superior to the mechanical in efficacy but require more preparation and are significantly more cost-intensive.

Reduction in hospital costs and resource consumption associated with the use of advanced topical hemostats during inpatient procedures.

OBJECTIVE: The use of hemostatic agents has increased over time for all surgical procedures. The purpose of this study was to evaluate the newer topical absorbable hemostat products Surgicel * Fibrillar † and Surgicel SNoW ‡ (Surgicel advanced products, abbreviated as SAPs) compared to the older product Surgicel Original (SO) with respect to healthcare resource use and costs in procedures where these hemostats are most commonly used. RESEARCH DESIGN AND METHODS: A retrospective analysis of the Premier hospital database was used to identify adults who underwent brain/cerebral (BC), cardiovascular (CV: valve surgery and coronary artery bypass graft) and carotid endarterectomy (CEA) between January 2011-December 2012. Among these patients, those treated with SAPs were compared to those treated with SO. Propensity score matching (PSM) was used to create comparable groups to evaluate differences between SAPs and SO. MAIN OUTCOME MEASURES: The primary end-points for this study were length of stay (LOS), all-cause total cost, number of intensive care unit (ICU) days, ICU cost, transfusion costs and units, and SO/SAP product units per discharge. RESULTS: Matched PSM created patient cohorts for SO and SAPs were created for BC (n = 758 for both groups), CV (n = 3388 for both groups), and CEA (n = 2041 for both groups) procedures. Patients that received SAPs had a 14-16% lower mean LOS for each procedure compared to SO, as well as 12-18% lower total mean cost per discharge for each procedure (p < 0.02 for all results). Mean ICU costs for SAPs were also lower, with a reduction of 20% for BC and 19% for CV compared to SO (p < 0.01). However, for CEA, there was no statistically significant difference in ICU costs for SAPs compared to SO. CONCLUSIONS: In a retrospective hospital database analysis, the use of SAPs were associated with lower healthcare resource utilization and costs compared to SO.

A low-cost and simple method to stop intraoperative leakage-type bleeding: use of the vancomycin-oxidized regenerated cellulose (ORC) sandwich.

Intraoperative bleeding may cause life-threatening complications in patients if such bleeding cannot be brought under control. Various materials are available for stopping such bleeding. However, there are some difficulties in the acquisition and application of these materials. The aim of this study was to investigate the efficiency of the low-cost and simple-to-prepare vancomycin-oxidized regenerated cellulose (ORC) sandwich in surgical bleeding control. Thirty New Zealand rabbits were used for this purpose. The animals were separated into three groups as group 1 (n = 10), control group; group 2 (n = 10), oxidized regenerated cellulose (ORC) group; and group 3 (n = 10), vancomycin-ORC sandwich group. Left thoracotomies were performed on the rabbits under general anesthesia, and bleeding was created in the parietal pleura. The amount of bleeding in the groups was measured and compared. The amount of bleeding in the group in which the vancomycin-ORC sandwich was used was found to be less, compared to the other two groups. According to these results, we conclude that the vancomycin-ORC sandwich can be used safely in the control of intraoperative leakage-type bleeding, as the vancomycin-ORC sandwich is a low-cost, easily applied, and easily acquired material.