OBJECTIVES: A five-year retrospective analysis using Premier US hospital database compared clinical outcomes using a hemostatic flowable matrix (Baxter Healthcare Corporation, Deerfield, IL) only (F) and hemostatic flowable matrix plus gelatin/thrombin flowable hemostat in combination (F+G/T) to achieve hemostasis and control surgical bleeding during spinal surgery (Ikeme et al., 2017)[1]. Lower resource use in F vs. F+G/T was characterized by shorter hospital length of stay, shorter surgical time, fewer blood transfusions, and less hemostat agent used per surgery. We evaluate the cost-consequence of F vs. F+G/T across all spinal surgery procedures from the US hospital perspective.

METHODS: A cost-consequence model was developed using clinical inputs from Ikeme et al. (2017), cost inputs (hemostatic matrices, blood product transfusion, hospital stay, and operating room time) from the literature, and annual spine surgery volume (minor, major, and severe) from the 2012 National Inpatient Sample (NIS) database. Costs are reported in 2017 USD. One-way and probabilistic sensitivity analyses address sources of variability.

RESULTS: A medium-volume hospital (base case: median=130 spine surgeries per year) using F vs. F+G/T would use 85 fewer hours of surgical time, 58 fewer hospital days, 7 fewer blood transfusions, and lower hemostat volume (hemostatic flowable matrix: 1mL, thrombin: 1,994mL). Potential annual cost savings from reduced hospital resource utilization for a medium-volume hospital are $317,959 (surgical hours=$154,746, hospital days=$125,237, blood transfusions=$19,023, hemostatic agents=$18,953) or $2,445 per surgery. Low-volume (25^th percentile=50) and high-volume (75^th percentile=300) hospitals showed annual cost savings of $122,292 and $733,752, respectively.

CONCLUSIONS: Based on estimated US hospital annual cost savings, there is potential for cost savings in spine surgery in European hospitals as well.

[1] Ikeme S, Deutsch H, Khanna N, et al. Clinical and Healthcare Resource Utilization Outcomes in Spine Surgery: A Retrospective Hospital Database Evaluation of Two Hemostatic Use Strategies. NASS (25-28 October 2017, Orlando, Florida).