Introduction: As the incidence of small renal masses rise, the role of the minimally invasive partial nephrectomy becomes increasingly prevalent. Hemostatic agents have and are used as a measure to reduce surgical complications. Here, we present our series to delineate the effectiveness and cost of hemostatic agents in the perioperative period.
Methods: We retrospectively analyzed all robotic partial nephrectomies at our center from January 2012 to July of 2018 by seven surgeons. We reviewed operative reports and billing to categorize the use of hemostatic agents (HA) and no hemostatic agents (NHA). The decision to use hemostatic agents was based on the surgeon discretion. Hemostatic agents used included hemostatic matrix (FloSeal), oxidized regenerated cellulose (Surgicel), absorbable gelatin (Gelfoam), fibrin sealant (TISSEEL), bovine collagen/thrombin (Vitagel) and bovine albumin/ glutaraldehyde (BioGlue).
Results: 389 patients were identified; 255 patients were categorized into the HA group and 134 within the NHA group. Demographics between the groups were found to be similar. Tumor size (HA 3.3cm±1.3 vs NHA 3.5cm±1.7, p=0.17) and RENAL Nephrometry score (HA 7.0±1.7 vs NHA 7.3±1.7, p=0.07) were equivalent.
Hospital hemoglobin decrease(HA 2.57 vs NHA 2.25, p=0.1), transfusions (HA 2.3% vs NHA 2.8%, p=0.7), ischemic time (HA 17 min vs NHA 2.25, p=0.8) and significant bleeds requiring intervention (HA 3% vs NHA 3.1%, p=0.95) were equivocal. Operative time was increased in the NHA at 230.5 minutes ±61 versus 206 minutes ±61, p<0.01. Within the HA, the average number of hemostatic agents was 2.2±2.1 with the average cost $311.65±124.45 (based on our institution charges for each specific agent). The HA group was further categorized into bolster (n=94) and non-bolster groups (n=161). Bleeds requiring intervention were 4.3% within the bolster group and 1% within the non-bolster group(p=0.08).
Conclusions: The use of hemostatic agents did not alter the incidence of immediate postoperative complications in robotic partial nephrectomy. However, cases that omitted the use did require a significantly increased operative time by roughly 30 minutes. Thus the use of hemostatic agents do come at additional costs but may be lessened by decreasing operative times. Source of