An international multidisciplinary peer-driven consensus on the optimal use of hemostatic powders in surgical practice
Por:
Eden, C, Buonomo, OC, Busch, J, Gilabert-Estelles, J, Medrano, R, Nosotti, M, Renaud, S, Walker, I, Williams, N, Carlini, M
Publicada:
1 ago 2021
Ahead of Print:
1 jul 2021
Resumen:
Bleeding is a consequence of insufficient hemostasis and excessive bleeding at a surgical site is associated with an increased risk of post-operative infection, transfusion and re-operation, in addition to increased hospital length of stay and costs. Surgeons employ a range of methods to achieve hemostasis, including topical hemostatic agents of differing composition and properties. Hemostatic powders are a sub-group of topical hemostats, which can be used in helping as adjuncts to manage troublesome bleeding in a variety of situations. As this technology is relatively new and potentially not well known by the broad surgical community, no specific guidelines or recommendations for the optimal use of hemostatic powders in surgery currently exist. A steering group throughout Europe of multidisciplinary surgeons, expert in hemostasis and hemostatics, identified from literature and from personal experience, five key topics. When to use hemostatic powder, the evidence for use, benefits of use, safety remarks and considerations in various surgical specialties. Thirty-seven statements were subsequently drawn from these five key topics. An online survey was sent to 128 high-volume surgeons working in breast surgery, gynaecological and obstetric surgery, general and emergency surgery, thoracic surgery and urological surgery in Europe to assess agreement (consensus) with these statements. Consensus was defined as high if >= 75% and very high if >= 90% of respondents agreed with a statement. A total of 79 responses were received and consensus among the surgical experts was very high in 27 (73%) statements, high in 8 (22%) statements and was not achieved in 2 (5%) statements. Based on the consensus scores, the steering group produced 16 key recommendations which they considered could improve patient outcomes by reducing post-operative bleeding and its associated complications using hemostatic powder.
Filiaciones:
Eden, C:
Royal Surrey Hosp, Dept Urol, Guildford, Surrey, England
Buonomo, OC:
Policlin Tor Vergata PTV Univ, Dept Surg Sci, Breast Unit, Rome, Italy
Busch, J:
Charite Univ Med Berlin, Dept Urol, Berlin, Germany
Gilabert-Estelles, J:
Hosp Gen Univ Valencia, Dept Paediat Obstet & Gynecol, Valencia, Spain
Medrano, R:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Nosotti, M:
Univ Milan, Fdn IRCCS Osped Maggiore Policlin, Milan, Italy
Renaud, S:
Reg Univ Hosp, Dept Thorac Surg, Nancy, France
Walker, I:
Triduc Partners Ltd, Tunbridge Wells, England
Williams, N:
Triduc Partners Ltd, Tunbridge Wells, England
Carlini, M:
S Eugenio Hosp, Dept Gen Surg, Piazzale Umanesimo 10, I-00144 Rome, Italy
Bronze, Green Published
|