Factors Associated With Hemostatic Agent Use During Laparoscopic Hysterectomy

• Published in: Journal of minimally invasive gynecology Vol. 23; no. 7; pp. 1167 - 1171
• Main Authors: Kakos, Andrea, MD, Allen, Valerie, MD, Whiteside, James, MD, MA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2016
• Subjects: Adult; Aged; Cohort Studies; Female; Fibrin sealants; Hemostatics - administration & dosage; Hemostats; Humans; Hysterectomy; Hysterectomy - methods; Laparoscopy - methods; Middle Aged; Obstetrics and Gynecology; Ohio; Postoperative Hemorrhage - prevention & control; Practice Patterns, Physicians; Retrospective Studies; Robotic Surgical Procedures - methods; Surgery; Hemostats; Fibrin sealants; Hysterectomy
• ISSN: 1553-4650; 1553-4669
• DOI: 10.1016/j.jmig.2016.08.827

Abstract Study Objective To evaluate factors associated with the use of hemostatic agents during traditional laparoscopic or robotic hysterectomy. Design A retrospective cohort trial (Canadian Task Force classification III). Setting A single medical center in Cincinnati, OH, from August 1, 2013, to July 31, 2014. Patients Women undergoing traditional laparoscopic or robotic hysterectomies with and without the use of hemostatic agents. Intervention The use of a hemostatic agent at the time of hysterectomy. Measurements Patient characteristics and pre- and postoperative metrics were recorded for each subject. Associations between categoric variables were analyzed using chi-square testing, whereas continuous variables were analyzed using analysis of variance. Modeling of study variables to predict hemostatic agent use was performed using chi-square–assisted interaction detection methods. Main Results The study sample included 176 cases performed by 30 surgeons. In our sample, 42% of minimally invasive hysterectomies were performed with the surgical robot (robotic-assisted laparoscopic hysterectomy); the remainder of minimally invasive hysterectomies by approach was as follows: total laparoscopic hysterectomy, 27%; laparoscopic-assisted vaginal hysterectomy, 16%; and laparoscopic supracervical hysterectomy, 15%. Forty-six percent (81/176) of cases recorded the use of a fibrin hemostat, 26% (46/176) involved an alternative hemostat, and 28% (49/176) of cases did not use any hemostat. By surgical approach, no hemostatic agent use was noted most often among laparoscopic-assisted hysterectomy; alternative hemostats were most often used during total laparoscopic hysterectomy. Robotic-assisted laparoscopic hysterectomy and laparoscopic supracervical hysterectomy were most often associated with fibrin-based hemostats. The use of any hemostatic agent did not result in clinical significant blood loss relative to cases in whino product was used. The study variable identified most predictive of hemostat use by the chi-square–assisted interaction detection regression tree model was surgeon identity. Conclusion Hemostatic agent use during traditional laparoscopic and robotic hysterectomy does not appear to be associated with operative bleeding but is related to surgeon identity.