Thrombin sponge speeds cervical spine surgery discharge

By Lynda Williams, Senior medwireNews Reporter

Application of a thrombin-soaked sponge after posterior cervical spine surgery allows patients to leave hospital earlier than normally expected, suggests research.

Patients whose exposed spine was treated with a single 100 cm2 absorbable gelatin compressed sponge soaked in 2500 IU of thrombin before closure had significantly lower total subfascial drain output than a group of retrospective controls (93 vs 204 mL), report Samuel Cho (Mount Sinai School of Medicine, New York, USA) and co-authors.

In addition, patients treated with the sponge took significantly fewer 8-hour shift periods than controls for their drainage output to decrease to below 30 mL per shift, at 2.5 versus 4.4. This resulted in a significantly shorter length of hospital stay, at 1.3 versus 2.2 days.

Noting there were no infections, epidurals, hematomas, or readmissions within 30 days of surgery in either group, the researchers emphasize that persistent drain output was the major reason for patients not being discharged on their first postoperative day.

The study, published in the US edition of the Journal of Bone and Joint Surgery, compared the outcomes of 43 patients who underwent arthrodesis with or without decompression, or decompression alone, with the sponge between 2008 and 2011. They were compared with 43 age-, gender-, procedure-, and blood loss-matched patients who underwent surgery between 2004 and 2007 without the sponge being applied.

The researchers say that all patients received "meticulous" hemostatic control, especially at sites of exposed bone and epidural vessels, using a combination of bipolar electrocautery, hemostatic matrix, and demineralized bone matrix soaked in thrombin.

"The retrospective nature of our analysis leaves room for other unidentified changes that may have occurred over the course of the data-collection period to confound the results of our study," Cho et al admit.

Nevertheless, they conclude: "A significant decrease in drain output and consequent length of hospital stay following the use of thrombin-soaked gelatin sponge in our patients appears to support the application of this hemostatic agent following posterior cervical arthrodesis and decompression procedures."

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