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
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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.
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.
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.
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.
KeywordsTotal hip arthroplasty Revision Blood management Transfusion Fibrin sealant Evicel
America Society of Anesthesiologists
Body mass index
Good clinical practice
Hepatitis C virus
Pound per square inch
Revision hip arthroplasty
Total knee replacement
Red blood cells
Range of motion
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.
All the authors of the present manuscript have nothing to disclose.
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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