Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: a multicenter observational study

Study design A prospective cohort study. Objectives Thrombin-gelatin matrix (TGM) is a rapid and potent hemostatic agent, but it has some limitations, including the cost and its preparation time. The purpose of this study was to investigate the current trend in the use of TGM and to identify the predictors for TGM usage in order to ensure its proper use and optimized resource allocation. Methods A total of 5520 patients who underwent spine surgery in a multicenter study group within a year were included in the study. The demographic factors and the surgical factors including spinal levels operated, emergency surgery, reoperation, approach, durotomy, instrumented fixation, interbody fusion, osteotomy, and microendoscopy-assistance were investigated. TGM usage and whether it was routine or unplanned use for uncontrolled bleeding were also checked. A multivariate logistic regression analysis was used to identify predictors for unplanned use of TGM. Results Intraoperative TGM was used in 1934 cases (35.0%), among which 714 were unplanned (12.9%). Predictors of unplanned TGM use were female gender (adjusted odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.02–1.43, p = 0.03), ASA grade ≥ 2 (OR: 1.34, 95% CI: 1.04–1.72, p = 0.02), cervical spine (OR: 1.55, 95% CI: 1.24–1.94, p < 0.001), tumor (OR: 2.02, 95% CI: 1.34–3.03, p < 0.001), posterior approach (OR: 1.66, 95% CI: 1.26–2.18, p < 0.001), durotomy (OR: 1.65, 95% CI: 1.24–2.20, p < 0.001), instrumentation (OR: 1.30, 1.03–1.63, p = 0.02), osteotomy (OR: 5.00, 2.76–9.05, p < 0.001), and microendoscopy (OR: 2.24, 1.84–2.73, p < 0.001). Conclusions Many of the predictors for unplanned TGM use have been previously reported as risk factors for intraoperative massive hemorrhaging and blood transfusion. However, other newly revealed factors can be predictors of bleeding that is technically challenging to control. While routine usage of TGM in these cases will require further justification, these novel findings are valuable for implementing preoperative precautions and optimizing resource allocation.