Trends, Cost, and Predictors of Local Hemostatics Use in Major Urological Surgery

被引:1
作者
Arenas-Gallo, Camilo [1 ]
Lewicki, Patrick [2 ]
Prunty, Megan [1 ]
Brant, Aaron [2 ]
Rhodes, Stephen [1 ]
Basourakos, Spyridon P. [2 ]
Zhu, Alec [2 ]
Al Awamlh, Bashir Al Hussein [3 ]
Shoag, Jonathan E. [1 ,2 ]
机构
[1] Univ Hosp Cleveland Med Ctr, Case Western Reserve Univ, Sch Med, Dept Urol, Cleveland, OH 44106 USA
[2] NewYork Presbyterian Hosp, Dept Urol, Weill Cornell Med, New York, NY 10065 USA
[3] Vanderbilt Univ, Med Ctr, Dept Urol, Nashville, TN USA
关键词
hemostatics; prostatectomy; cystectomy; FLOSEAL;
D O I
10.1097/UPJ.0000000000000438
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction:The national usage and cost trends associated with hemostatic agents in major urologic procedures remain unknown. This study aims to describe the trends, costs, and predictors of local hemostatic use in major urologic surgeries.Methods:We utilized the Premier Healthcare Database to analyze 385,261 patient encounters between 2000 and 2020. Our primary objective was to describe the usage patterns of topical hemostatic agents in open and laparoscopic/robotic major urological surgeries. The data from the last 5 years (2015-2020) were used to characterize specific cost trends, and multivariable regression analysis was performed to identify predictors of hemostatic agent use in relation to surgical approach, patient, and hospital characteristics.Results:By 2020, at least 1 topical hemostatic agent was used in 37.3% (95% CI: 35.5-39.1) of laparoscopic/robotic prostatectomies and 30.7% (95% CI: 24.2-37.1) of open prostatectomies; 60.8% (95% CI: 57.6-64.1) of laparoscopic/robotic partial nephrectomies and 55.9% (95% CI: 47.3-64.5) of open partial nephrectomies; 40.7% (95% CI: 36.9-44.3) of laparoscopic/robotic radical nephrectomies and 43.2% (95% CI: 38.8-47.6) of open radical nephrectomies; and 40.52% (95% CI: 35.02-46.02) of open radical cystectomies. For the 2015-2020 cohort, predictors for hemostatic agent use varied by surgery type and included gender, race, surgical approach, insurance coverage, geographical location, urbanicity, and attending volume. The cost of the hemostatic agent accounted for less than 1.6% of the total cost of hospitalization for each procedure.Conclusions:The use of hemostatic agents in major urologic surgeries has grown over the past 2 decades. For all procedures, the specific cost of using a hemostatic agent constitutes a small fraction of the total hospitalization cost and does not vary significantly between open and laparoscopic/robotic approaches. Some patient, surgeon, and hospital characteristics are highly correlated with their use.
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收藏
页码:569 / 577
页数:11
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