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Kato S, Miyahara J, Matsubayashi Y, Taniguchi Y, Doi T, Kodama H, Higashikawa A, Takeshita Y, Fukushima M, Ono T, Hara N, Azuma S, Iwai H, Oshina M, Sugita S, Hirai S, Masuda K, Tanaka S, Oshima Y. Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: a multicenter observational study. BMC Musculoskelet Disord 2023; 24:289. [PMID: 37055735 PMCID: PMC10099820 DOI: 10.1186/s12891-023-06408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/07/2023] [Indexed: 04/15/2023] Open
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVES Thrombin-gelatin matrix (TGM) is a rapid and potent hemostatic agent, but it has some limitations, including the cost and its preparation time. The purpose of this study was to investigate the current trend in the use of TGM and to identify the predictors for TGM usage in order to ensure its proper use and optimized resource allocation. METHODS A total of 5520 patients who underwent spine surgery in a multicenter study group within a year were included in the study. The demographic factors and the surgical factors including spinal levels operated, emergency surgery, reoperation, approach, durotomy, instrumented fixation, interbody fusion, osteotomy, and microendoscopy-assistance were investigated. TGM usage and whether it was routine or unplanned use for uncontrolled bleeding were also checked. A multivariate logistic regression analysis was used to identify predictors for unplanned use of TGM. RESULTS Intraoperative TGM was used in 1934 cases (35.0%), among which 714 were unplanned (12.9%). Predictors of unplanned TGM use were female gender (adjusted odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.02-1.43, p = 0.03), ASA grade ≥ 2 (OR: 1.34, 95% CI: 1.04-1.72, p = 0.02), cervical spine (OR: 1.55, 95% CI: 1.24-1.94, p < 0.001), tumor (OR: 2.02, 95% CI: 1.34-3.03, p < 0.001), posterior approach (OR: 1.66, 95% CI: 1.26-2.18, p < 0.001), durotomy (OR: 1.65, 95% CI: 1.24-2.20, p < 0.001), instrumentation (OR: 1.30, 1.03-1.63, p = 0.02), osteotomy (OR: 5.00, 2.76-9.05, p < 0.001), and microendoscopy (OR: 2.24, 1.84-2.73, p < 0.001). CONCLUSIONS Many of the predictors for unplanned TGM use have been previously reported as risk factors for intraoperative massive hemorrhaging and blood transfusion. However, other newly revealed factors can be predictors of bleeding that is technically challenging to control. While routine usage of TGM in these cases will require further justification, these novel findings are valuable for implementing preoperative precautions and optimizing resource allocation.
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Affiliation(s)
- So Kato
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Junya Miyahara
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyasu Kodama
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kizukisumiyoshi- cho, Nakahara-ku, Kawasaki, 211-8510, Japan
| | - Yujiro Takeshita
- Department of Orthopedic Surgery, Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211 Kozukue-Chō, Kōhoku-Ku, 222-0036, Yokohama, Japan
| | - Masayoshi Fukushima
- Spine center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, 105-8470, Tokyo, Japan
| | - Takashi Ono
- Department of Spinal Surgery, Community Health-Care Organization Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, 162-8543, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashino, 180-8610, Tokyo, Japan
| | - Seiichi Azuma
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, 330-8553, Saitama, Japan
| | - Hiroki Iwai
- Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, 133- 0056, Tokyo, Japan
| | - Masahito Oshina
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashi- Gotanda, Shinagawa-ku, 141-8625, Tokyo, Japan
| | - Shurei Sugita
- Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, 113-8677, Tokyo, Japan
| | - Shima Hirai
- Department of Orthopedic Surgery, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, 252-0392, Sagamihara, Kanagawa, Japan
| | - Kazuhiro Masuda
- Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, 183-8524, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Affiliation(s)
- Hadi Seikaly
- From the Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
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Ambulatory management of common ENT emergencies - what's the evidence? The Journal of Laryngology & Otology 2021; 135:191-195. [PMID: 33593465 DOI: 10.1017/s0022215121000554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. METHODS A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. RESULTS Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. CONCLUSION In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.
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Milinis K, Swords C, Hardman JC, Slovick A, Hutson K, Kuhn I, Smith ME. Dissolvable intranasal haemostatic agents for acute epistaxis: A systematic review and meta-analysis. Clin Otolaryngol 2021; 46:485-493. [PMID: 33453137 DOI: 10.1111/coa.13717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/14/2020] [Accepted: 12/26/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Nasal packing is the mainstay of epistaxis management; however, packs cause patient discomfort and can lead to hospital admission. Absorbable haemostats provide clotting factors or act as a substrate to stimulate clotting and represent a potential treatment alternative. A systematic review was performed to evaluate the efficacy of topical haemostats in the management of epistaxis. METHODS A systematic literature search of 7 databases was performed. Only eligible randomised controlled trials (RCTs) and observational studies were included. The primary outcome was short-term haemostatic success (<7 days). Secondary outcomes included long-term haemostatic control (no rebleeding 7-30 days), patient discomfort and adverse effects. Meta-analysis was performed where possible. RESULTS Of 2249 records identified, 12 were included in the qualitative synthesis and 4 RCTs were included in meta-analysis. The following haemostats were reported: gelatin-thrombin matrix (n = 8), aerosolised/gel tranexamic acid (n = 1), cellulose agents (n = 2) and fibrin sealants (n = 1). Studies involving tranexamic acid on removable delivery devices (eg, pledgets) were excluded. There was heterogeneity in outcome measures and inclusion criteria (coagulopathies/anticoagulants were excluded in 3 RCTs and 2 observational studies). The short-term haemostatic success varied between studies (13.9% to 100%). No significant post-procedural complications were reported. The meta-analysis favoured absorbable haemostatic agent versus packing (risk ratio 1.20; 95% confidence interval 1.05 to 1.37; P = .007). The risk of bias across all studies was moderate to high. CONCLUSIONS The evidence suggests haemostatic agents are effective at managing acute epistaxis when compared with nasal packing. More data are required before recommendations can be made regarding management in patients on anticoagulants.
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Affiliation(s)
| | - Chloe Swords
- Ear, Nose and Throat Department, Addenbrooke's Hospital, Cambridge, UK
| | - John C Hardman
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Anna Slovick
- Ear, Nose and Throat Department, Barts Health NHS Trust, London, UK
| | - Kristian Hutson
- Ear, Nose and Throat Department, Addenbrooke's Hospital, Cambridge, UK
| | - Isla Kuhn
- School of Medicine, University of Cambridge, Cambridge, UK
| | - Matthew E Smith
- Ear, Nose and Throat Department, Addenbrooke's Hospital, Cambridge, UK
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Bonduelle Q, Biggs TC, Sipaul F. Floseal: A novel application technique for the treatment of challenging epistaxis. Clin Otolaryngol 2020; 45:960-962. [PMID: 32608145 DOI: 10.1111/coa.13604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Quentin Bonduelle
- Core Surgical Trainee, Nottingham University Hospital NHS Foundation Trust, Nottingham, UK
| | - Timothy C Biggs
- Academic Specialist Registrar in Otorhinolaryngology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fabian Sipaul
- Head and Neck Surgeon, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Dang NC, Ardehali A, Bruckner BA, Parrino PE, Gillen DL, Hoffman RW, Spotnitz R, Cavoores S, Shorn IJ, Manson RJ, Spotnitz WD. Prospective, multicenter, randomized, controlled trial evaluating the performance of a novel combination powder vs hemostatic matrix in cardiothoracic operations. J Card Surg 2019; 35:313-319. [PMID: 31763732 PMCID: PMC7003826 DOI: 10.1111/jocs.14376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim This trial compared the hemostatic performance of a novel combination powder (CP) to a control hemostatic matrix (HM) in cardiothoracic operations. Methods Patients meeting eligibility criteria were enrolled after providing informed consent. Subjects were randomized intraoperatively to receive CP (HEMOBLAST Bellows; Biom'up, France) or HM (FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, CA). Bleeding was assessed using a clinically validated, quantitative bleeding severity scale. The primary endpoint was total time to hemostasis (TTTH), from the start of device preparation, as an indicator of when a surgeon asks for a surgical hemostat until hemostasis was achieved. TTTH at 3 minutes was utilized for the primary analysis, while TTTH at 5 minutes was considered as a secondary endpoint. Results A total of 105 subjects were enrolled across four institutions. The primary efficacy endpoint for the superiority of CP relative to HM for success at achieving hemostasis within 3 minutes was met, with 64.2% of the CP group achieving hemostasis compared with 9.6% of the HM group, a difference of 54.54% (37.4%‐71.6%; P < .001 for superiority). The secondary efficacy endpoint was also met, with 92.5% of the CP group achieving hemostasis at 5 minutes versus 44.2% in the HM group, a difference of 48.2% (31.1%‐65.4%; P < .001 for noninferiority). There were no device‐related adverse events. Conclusions In this multicenter, randomized, controlled trial, comparison of CP to HM revealed CP superiority and noninferiority for TTTH at 3 and 5 minutes, respectively.
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Affiliation(s)
- Nicholas C Dang
- Department of Surgery, Kaiser Moanalua Medical Center, Honolulu, Hawaii
| | - Abbas Ardehali
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Brian A Bruckner
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Patrick E Parrino
- Thoracic and Cardiovascular Surgery Section, Ochsner Medical Center, New Orleans, Louisiana
| | - Daniel L Gillen
- Department of Statistics, University of California, Irvine, California
| | | | | | | | | | - Roberto J Manson
- Biom'up SA, Lyon, France.,Department of Surgery, Duke University, Durham, North Carolina.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina
| | - William D Spotnitz
- Biom'up SA, Lyon, France.,Department of Surgery, University of Virginia, Charlottesville, Virginia
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Smith J, Hanson J, Chowdhury R, Bungard TJ. Community-based management of epistaxis: Who bloody knows? Can Pharm J (Ott) 2019; 152:164-176. [PMID: 31156729 DOI: 10.1177/1715163519840380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jenna Smith
- Alberta Health Services (Smith), University of Alberta Hospital.,Anticoagulation Management Services (Hanson), University of Alberta Hospital.,Division of Otolaryngology Head and Neck Surgery (Chowdhury), University of Alberta, Edmonton, Alberta.,Division of Cardiology (Bungard), University of Alberta, Edmonton, Alberta
| | - Jennifer Hanson
- Alberta Health Services (Smith), University of Alberta Hospital.,Anticoagulation Management Services (Hanson), University of Alberta Hospital.,Division of Otolaryngology Head and Neck Surgery (Chowdhury), University of Alberta, Edmonton, Alberta.,Division of Cardiology (Bungard), University of Alberta, Edmonton, Alberta
| | - Raiyan Chowdhury
- Alberta Health Services (Smith), University of Alberta Hospital.,Anticoagulation Management Services (Hanson), University of Alberta Hospital.,Division of Otolaryngology Head and Neck Surgery (Chowdhury), University of Alberta, Edmonton, Alberta.,Division of Cardiology (Bungard), University of Alberta, Edmonton, Alberta
| | - Tammy J Bungard
- Alberta Health Services (Smith), University of Alberta Hospital.,Anticoagulation Management Services (Hanson), University of Alberta Hospital.,Division of Otolaryngology Head and Neck Surgery (Chowdhury), University of Alberta, Edmonton, Alberta.,Division of Cardiology (Bungard), University of Alberta, Edmonton, Alberta
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Mısırlıoğlu S, Türkgeldi E, Yağmur H, Urman B, Ata B. Use of a gelatin-thrombin hemostatic matrix in obstetrics and gynecological surgery. Turk J Obstet Gynecol 2018; 15:193-199. [PMID: 30202631 PMCID: PMC6127479 DOI: 10.4274/tjod.90217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/24/2018] [Indexed: 12/28/2022] Open
Abstract
Gelatin-thrombin matrix (GTM) is a hemostatic sealant consisting of bovine-derived gelatin matrix and human-derived thrombin, combining both mechanical and active mechanisms to achieve hemostasis. It was approved by the Food and Drug Administration in 1999. GTM has been used by several surgical specialties; however, it is a possibly an under-used tool in obstetrics and gynecology. A limited number of studies have been performed on its use during laparoscopic endometrioma excision and myomectomy. It may prove useful in endometrioma excision in reproductive aged women because it is likely to harm ovarian reserve less than electrocautery; however, this conclusion needs to be validated. The only study on GTM use in myomectomy included 50 women randomized into GTM and control groups, and showed decreased blood loss and shorter hospital stays in the GTM group. In gynecologic oncology, it was successfully used to reduce lymphocele cases in a cohort study. GTM has been used successfully in obstetrics in a handful of cases of uncontrolled bleeding from caesarean scar, placental site, ectopic pregnancy, rectovaginal hematoma, and venous plexus over the vaginal vault after emergency postpartum hysterectomy. Risk of viral transmission is a major concern about GTM, yet there are no reports on disease transmission with GTM use to date. Rare but serious adverse effects and complications have been reported such as fatal or near-fatal thromboembolism and small bowel obstruction. Although GTM is mostly a safe product, it is still not free of complications and risks. In conclusion, although routine use of GTM cannot be recommended due to concerns about its safety, cost, and availability, it may prove useful when conventional hemostatic methods such as suturing and electrocauterization fail or are not appropriate.
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Affiliation(s)
- Selim Mısırlıoğlu
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Engin Türkgeldi
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Hande Yağmur
- Koç University Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Bülent Urman
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Barış Ata
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Le A, Thavorn K, Lasso A, Kilty SJ. Economic evaluation of floseal compared to nasal packing for the management of anterior epistaxis. Laryngoscope 2018; 128:1778-1782. [DOI: 10.1002/lary.27081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/22/2017] [Accepted: 12/08/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Andre Le
- Department of Otolaryngology–Head and Neck Surgery
| | - Kednapa Thavorn
- School of Epidemiology and Public HealthUniversity of OttawaOttawa Ontario Canada
- Ottawa Hospital Research InstituteOttawa Ontario Canada
- Institute for Clinical and Evaluative SciencesICES@uOttawaOttawa Ontario Canada
| | - Andrea Lasso
- Ottawa Hospital Research InstituteOttawa Ontario Canada
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Efficiency and safety of oral tranexamic acid in total joint arthroplasty: A meta-analysis of randomized controlled trial. Int J Surg 2017; 47:148-150. [PMID: 28935531 DOI: 10.1016/j.ijsu.2017.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 09/12/2017] [Indexed: 11/23/2022]
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