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Use of a fibrin sealant within a blood-saving protocol in patients undergoing revision hip arthroplasty: effects on post-operative blood transfusion and healthcare-related cost analysis

  • Marco Scardino
  • Federica Martorelli
  • Tiziana D’Amato
  • Giorgia Fenocchio
  • Vincenzo Simili
  • Guido Grappiolo
  • Berardo Di MatteoEmail author
  • Elizaveta Kon
  • Michele Lagioia
Original Paper
  • 59 Downloads

Abstract

Purpose

Blood transfusion and blood management are important aspects in orthopaedic surgery. Strategies include intra-operative and post-operative blood salvage and even the use of fibrin sealant in selected case. Objectives of the study were (1) to compare the total number of transfusions and the length of hospital stay in patients undergoing complete revision hip arthroplasty (RHA) with and without the use of a fibrin sealant (EVICEL®) and (2) to evaluate the possible role in cost savings of EVICEL® in association with the blood-saving protocol.

Methods

Retrospective observational study evaluating patients undergoing complete RHA (stem + cup) with a blood-saving protocol with (n = 50) and without EVICEL® (n = 60). The outcome measures were: number of patients transfused (allogeneic red blood cells—RBC—and plasma), amount of blood/plasma transfusions, quantity of re-infused recycled blood, and length of hospital stay. An economic model was developed to assess the differences in costs between the two groups.

Results

EVICEL® reduced the number of transfused red blood cells and plasma (p < 0.001), and the hospital stay (p = 0.01) compared to control group. EVICEL® can induce a reduction in resource consumption with an average cost-savings of €1.676 per patient.

Conclusion

EVICEL® may be effective in reducing red blood cells and plasma transfusion as well as hospital stay. The inclusion of EVICEL® in a blood-saving protocol seems to produce clinical efficacy and cost savings.

Keywords

Total hip arthroplasty Revision Blood management Transfusion Fibrin sealant Evicel 

Abbreviations

ASA

America Society of Anesthesiologists

BMI

Body mass index

GCP

Good clinical practice

Hb

Haemoglobin

HCV

Hepatitis C virus

PSI

Pound per square inch

RHA

Revision hip arthroplasty

TKR

Total knee replacement

RBC

Red blood cells

ROM

Range of motion

Notes

Compliance with ethical standards

The study protocol was notified to Humanitas Research Hospital (ICH) Ethical Committee. During the study, the data were collected in complete anonymity and handled according to the local law on privacy. The ICH blood management protocol is compliant with the Declaration of Helsinki, to standards EN ISO 14155:1, EN ISO 14155:2 and Good Clinical Practices (GCP). Moreover, all personnel involved in the study agreed to act in accordance with the principles contained in these GCPs.

Disclosure statement

All the authors of the present manuscript have nothing to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Marco Scardino
    • 1
  • Federica Martorelli
    • 1
  • Tiziana D’Amato
    • 1
  • Giorgia Fenocchio
    • 1
  • Vincenzo Simili
    • 1
  • Guido Grappiolo
    • 2
  • Berardo Di Matteo
    • 3
    • 4
    Email author
  • Elizaveta Kon
    • 3
    • 4
  • Michele Lagioia
    • 4
  1. 1.Anesthesiology Hip and Knee Replacement UnitHumanitas Clinical and Research CenterMilanItaly
  2. 2.Hip Diseases and Joint Replacement Surgery UnitHumanitas Clinical and Research CenterMilanItaly
  3. 3.Department of Biomedical SciencesHumanitas UniversityMilanItaly
  4. 4.Humanitas Clinical and Research CenterMilanItaly

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