Bleeding-Related Complications and Readmission Rates Associated With Fibrin Sealant Use in Patients Undergoing Coronary Artery Bypass Graft Surgery in the United States

Objectives To compare the clinical and economic outcomes of EVICEL (Ethicon, Inc., Somerville, NJ) and TISSEEL (Baxter Healthcare Corporation, Westlake Village, CA) use in patients undergoing primary coronary artery bypass graft (CABG) surgery. Design Retrospective database analysis. Setting Premier...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2017-06, Vol.31 (3), p.876-882
Main Authors: Wan, Yin, MS, Lim, Sangtaeck, MPH, Gao, Xin, PhD, Danker, Walter A., PhD, Kocharian, Richard, Phd, MD, Gangoli, Gaurav, PharmD, DeAnglis, Ashley P., PhD, Hart, James, MD, FACS
Format: Article
Language:English
Subjects:
Aged
Anesthesia & Perioperative Care
bleeding complications
CABG surgery
clotting
coagulation
Coronary Artery Bypass - adverse effects
Coronary Artery Bypass - trends
Critical Care
Databases, Factual - trends
Female
fibrin sealants
Fibrin Tissue Adhesive - adverse effects
Hemorrhage - diagnosis
Hemorrhage - epidemiology
Hemorrhage - etiology
Hemostatics - adverse effects
hospital costs
Humans
Male
Middle Aged
Patient Readmission - trends
Postoperative Complications - diagnosis
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Prospective Studies
Retrospective Studies
transfusions
United States - epidemiology
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Summary:Objectives To compare the clinical and economic outcomes of EVICEL (Ethicon, Inc., Somerville, NJ) and TISSEEL (Baxter Healthcare Corporation, Westlake Village, CA) use in patients undergoing primary coronary artery bypass graft (CABG) surgery. Design Retrospective database analysis. Setting Premier prospective hospital database (June 2009 through March 2014) covering approximately 20% of hospital discharges in the United States. Participants Adults undergoing primary CABG surgery who received either EVICEL or TISSEEL on the day of surgery (index date). Interventions Two intervention groups were formed, EVICEL and TISSEEL. Clinical outcomes compared included postoperative bleeding complications (International Classification of Diseases, Ninth Revision, Clinical Modification code: 998.1) and number of blood transfusions received on the index day. Economic outcomes compared included hospital length of stay, hospital costs, and 30-day readmission rates. Propensity-score matching was used to control for patient and hospital characteristics. Measurements and Main Results A total of 129,014 primary CABG surgery patients were identified; 986 patients (mean age: 64 years, 73% male) received EVICEL and 6,340 patients (mean age: 65 years, 75% male) received TISSEEL on the index day. After propensity-score matching, patients who received EVICEL compared with TISSEEL had significantly fewer postoperative bleeding complications (3.0% v 5.0%, p = 0.0197), index-day blood transfusion rates (19% v 34%, p
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2016.11.015