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Surgical Treatment of Pressure Ulcers with a Fibrin Sealant in Patients with Spinal Cord Injury: A Cost-Consequence Analysis

Velasco, Jose Manuel Arévalo MD; Lozano, Virginia PhD; Oyagüez, Itziar MSc, BSc; Casado, Miguel Angel PhD

doi: 10.1097/01.ASW.0000471875.06135.a1
Features: Original Investigations

BACKGROUND: A comparative study was performed to evaluate the effectiveness and costs of a fibrin sealant (Tissucol Duo [known as Tisseel in the United States], Baxter International, Deerfield, Illinois) to improve postoperative outcomes in patients with spinal cord injury undergoing surgical treatment for pressure ulcers (PrUs).

METHODS: Between January and June 2011, 27 patients underwent surgical treatment for PrUs with the direct application of Tissucol Duo sprayed before closure. The costs and outcomes obtained in this cohort were compared with those obtained in a previous retrospective study where 71 patients underwent conventional surgery.

RESULTS: Lower rates of hematoma-seroma were observed in the study group (3.7% vs 33.8%; P < .05). Drain removal occurred earlier (10 vs 15 days; P < .05), and the average drain volume was also lower (155 vs 360 mL; P < .05) for this group. The mean length of hospital stay was significantly lower in the study group and was the main contributing factor to the overall costs.

CONCLUSIONS: The application of Tissucol Duo during surgical treatment of PrUs in patients with spinal cord injury has been shown to be effective in reducing postoperative complications and in shortening the duration of the hospital stay with a consequent savings in costs.

Jose Manuel Arévalo Velasco, MD, is a Plastic Surgeon in the Department of Plastic Surgery, Reconstructive and Aesthetic Surgery, National Hospital for Paraplegics, Toledo, Spain. Virginia Lozano, PhD, is Health Economics Specialist; Itziar Oyagüez, MSc, BSc, is Associate Director, and Miguel Angel Casado, PhD, is Managing Director, all at Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain. Dr Velasco disclosed that he received an award in 2011 from Baxter Spain for his research reported in this article. Dr Lozano, Mr Oyagüez, and Dr Casado disclosed that their institution has received a consulting fee/honorarium and payment for writing/reviewing a manuscript from Baxter.

Acknowledgments: The authors thank Maria Sierra for her collaboration in contributing as a librarian-documentalist in the reference search, Juan Carlos Monroy for making the figures, and Francisco Javier Espino-Rodríguez and Pablo Cabello-Granado for their collaboration in the data collection and the study development.

Submitted January 31, 2014; accepted in revised form September 15, 2014.

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