PMS6 - Improved Outcomes and Neutral Hospital Budget Impact Associated with Flowable Gelatin for Lumbar Surgery in a Chinese Tertiary Care Hospital: A Retrospective Case-Series Study

Abstract

To assess the clinical and economic impact of flowable gelatin hemostatic matrix (SURGIFLO®) for lumbar surgery (LS) in a Chinese tier III hospital, the first such real-world outcomes study in LS. Patients operated by one surgeon for lumbar disc herniation or disc stenosis from 2014-2016 in a Chinese tier III hospital were included. Historical control cohort (HC) comprised patients who underwent LS in 2014 before the introduction of SURGIFLO®. Flowable gelatin cohort (FG) comprised patients who received SURGIFLO® during LS in 2015-2016. From patient medical records and hospital cost data, propensity score and regression analyses were conducted for adjusted comparisons of surgical outcomes and hospital expenses between cohorts. 64 pairs of patients matched from FG (n=108) and HC (n=82) had well balanced patient characteristics and procedure characteristics, e.g. lumbar fusion level and procedure method (posterior lumbar interbody fusion or minimally invasive surgery transforaminal lumbar interbody fusion). In matched HC, oxidized regenerated cellulose or collagen were the most frequently utilized hemostatic products (92.7%). Matched comparisons also observed that FG was associated with significantly lower: blood transfusion rate (34.4% vs. 64.1%, p=0.005), blood transfusion volume (183 ± 312 vs. 301 ± 281 mL, p=0.045), and post-operation drainage tub placement rate (82.8% vs. 93.8%, p=0.046). Multiple regression analysis confirmed the significantly lower blood transfusion risk (odds ratio 0.115, p<0.001) and blood transfusion volume (coefficient -101.820, p=0.003) associated with FG, and showed comparable total hospital costs between cohorts (coefficient -0.001, p=0.972). Patients who received FG in LS within the Chinese tertiary care setting, compared to those who received oxidized regenerated cellulose or collagen, show significantly reduced rate and volume of blood transfusion. In addition, utilization of FG in LS did not increase hospitalization expenses. These results warrant further study to confirm the positive findings on a larger scale.