Hemostatic agent use during partial nephrectomy: trends, outcomes, and associated costs

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Partial nephrectomy (PN) is a standard treatment for kidney cancer.
• Bleeding complications are a concern following PN.
• Hemostatic agents (HA) are often used to manage bleeding during surgery.

Purpose of the Study:

• To evaluate the efficacy of hemostatic agents (HA) in reducing bleeding complications after partial nephrectomy (PN).
• To determine the usage patterns and costs associated with HA.
• To identify factors influencing post-operative bleeding complications.

Main Methods:

• Retrospective review of 429 partial nephrectomies (PN) for kidney cancer.
• Analysis of clinical, pathological, and perioperative variables, including surgical approach and HA use.
• Logistic regression models to identify factors associated with bleeding complications.

Main Results:

• HA use was associated with longer operative times, ischemia, and estimated blood loss.
• Neither HA use nor the number of agents used correlated with reduced bleeding complications.
• Increasing RENAL score and specific surgical approaches (OPN, LPN) were independently associated with bleeding complications.
• Total expenditure on HA over 16 years was $77,687 USD, with significant annual variations.

Conclusions:

• Hemostatic agent use during PN was not associated with a decrease in bleeding complications.
• Judicious and case-specific application of HA is necessary to minimize costs.
• Cost-effectiveness of HA in PN requires careful consideration based on individual patient factors and surgical approach.