Resource Use Impact of Management Strategies for Local Haemostasis and Sealing: the Surgeons’ Perspective

Abstract

Aim: The aim of this study was to evaluate treatments for haemostasis and the potential hospital resource use implications of these treatments by way of expert assessment.

Methods: This analysis was based on data from a non-interventional surveillance study, which enrolled 3098 patients at 227 centres in 12 European countries. All patients received a haemostatic sealing patch (TachoSil^®, Nycomed GmbH, Zurich, Switzerland), with the decision to use TachoSil made by the surgeon. Data on duration of surgery, hospital length of stay (LOS) and use of blood products were collected. Surgeons were asked to compare TachoSil with products or procedures they would otherwise have used.

Results: Mean duration of surgery was 192.1 minutes and mean hospital LOS was 17.5 days. According to surgeons, operating time would have been significantly reduced with TachoSil versus the potential alternative in 55.5 % of patients (p < 0.001). Surgeons predicted that the use of TachoSil would reduce duration of surgery by 12.2 minutes. Choice of alternative treatment, type of surgery and country had a significant effect on surgeons’ assessment. TachoSil was thought to offer greater benefits in anti-coagulated patients with a normal pre-operative coagulation test and in emergency surgery.

Conclusion: The use of topical haemostatic agents such as TachoSil may offer benefits with regard to hospital resource use.

Zusammenfassung

Ziel: Das Ziel dieser Studie war Behandlungsoptionen der Blutstillung und deren Auswirkungen auf den potenziellen Ressourcenverbrauch im Krankenhaus mittels Bewertung durch Experten zu beurteilen.

Methoden: Diese Analyse basierte auf den Daten einer nicht interventionellen Beobachtungsstudie, in die 3098 Patienten in 227 Zentren in 12 Ländern in Europa eingeschlossen worden waren. Alle Patienten erhielten ein blutstillendes Vlies (TachoSil^®, Nycomed GmbH, Zürich, Schweiz), wobei die Entscheidung zur Anwendung durch den Chirurgen getroffen wurde. Es wurden Daten zur Dauer des chirurgischen Eingriffs, der Länge des stationären Aufenthalts (LOS) und des Verbrauchs von Blutprodukten erhoben. Die Chirurgen wurden gebeten, TachoSil^® mit Produkten oder Prozeduren zu vergleichen, die sie ansonsten angewendet hätten.

Ergebnisse: Die mittlere Eingriffsdauer betrug 192,1 min und die mittlere Dauer des Krankenhausaufenthalts betrug 17,5 Tage. Den Chirurgen zufolge wäre die Operationszeit mit TachoSil^® im Vergleich zu den potenziellen Alternativen bei 55,5 % der Patienten signifikant verkürzt worden (p < 0,001). Die Chirurgen gaben an, dass durch die Anwendung von TachoSil^® die Dauer des chirurgischen Eingriffs um 12,2 min verkürzt worden wäre. Die Auswahl der alternativen Behandlungsmethoden, die Art des chirurgischen Eingriffs sowie das Land hatten einen signifikanten Einfluss auf die Einschätzung der Chirurgen. Es wurde die Meinung vertreten, dass TachoSil^® einen größeren Nutzen bei antikoagulierten Patienten mit unauffälliger präoperativer Gerinnung und bei der Notfallchirurgie habe.

Schlussfolgerung: Die Durchführung einer lokalen Blutstillung mit TachoSil^® bietet möglicherweise einen Nutzen hinsichtlich des Ressourcenverbrauchs im Krankenhaus.

Key words

surgery - haemostasis - haemostatic agents - tissue sealing - TachoSil

Schlüsselwörter

Chirurgie - Blutstillung - blutstillendes Medikament - Gewebeversiegelung - TachoSil^®

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