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Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: a multicenter observational study
So Kato1, Junya Miyahara2, Yoshitaka Matsubayashi2
1Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. sokato@g.ecc.u-tokyo.ac.jp.
BMC Musculoskeletal Disorders
|April 13, 2023
Summary
Thrombin-gelatin matrix (TGM) is a hemostatic agent used in spine surgery. Predictors for unplanned TGM use include female gender, higher ASA grade, cervical spine procedures, tumors, posterior approaches, durotomy, instrumentation, osteotomy, and microendoscopy.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Surgical Hemostasis
Background:
- Thrombin-gelatin matrix (TGM) is an effective hemostatic agent but has limitations.
- Understanding TGM usage trends and predictors is crucial for optimizing its application and resource allocation in spine surgery.
Purpose of the Study:
- To investigate the current trends in TGM utilization during spine surgery.
- To identify predictors associated with the unplanned use of TGM.
Main Methods:
- A prospective cohort study involving 5520 patients undergoing spine surgery.
- Analysis of demographic and surgical factors, including TGM usage (routine vs. unplanned).
- Multivariate logistic regression used to determine predictors of unplanned TGM use.
Main Results:
- Intraoperative TGM was used in 35.0% of cases, with 12.9% being unplanned.
- Predictors for unplanned TGM use included female gender, ASA grade ≥2, cervical spine surgery, tumors, posterior approach, durotomy, instrumentation, osteotomy, and microendoscopy-assistance.
Conclusions:
- Several predictors of unplanned TGM use are associated with increased risk of intraoperative bleeding and transfusion.
- Newly identified factors suggest challenges in controlling bleeding during specific surgical scenarios.
- Findings aid in preoperative planning and optimizing TGM resource allocation, though routine use requires further justification.
