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Hemostatic Techniques Reduce Hospital Stay Following Multilevel Posterior Cervical Spine Surgery
Samuel K. Cho, MD1; Jin-Seok Yi, MD2; Moon Soo Park, MD3; Guangxun Hu, MD2; Lukas P. Zebala, MD2; Joshua M. Pahys, MD2; Matthew M. Kang, MD2; Dong-Ho Lee, MD4; K. Daniel Riew, MD2
1 Department of Orthopaedics, Mount Sinai School of Medicine, 5 East 28th Street, Box 1188, New York, NY 10029
2 Department of Orthopaedic Surgery, Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for K.D. Riew: riewd@wudosis.wustl.edu
3 Department of Orthopaedic Surgery, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu Anyang-si, Gyeonggi-do 431-070, South Korea
4 Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, 388-1 Pungnap 2-dong, Songpa-gu, Seoul 138-736, South Korea
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  • Disclosure statement for author(s): PDF

Investigation performed at the Cervical Spine Service, Washington University School of Medicine, St. Louis, Missouri

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Nov 07;94(21):1952-1958. doi: 10.2106/JBJS.K.00632
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Despite meticulous hemostasis, persistent postoperative drain output following posterior cervical spine procedures often necessitates a prolonged length of hospital stay. We sought to determine if thrombin-soaked absorbable gelatin compressed sponge can decrease postoperative drain output and the length of hospital stay after multilevel posterior cervical spine surgery.


We performed a retrospective analysis of forty-three pairs of patients who had undergone either posterior cervical decompression and/or fusion of three or more levels by the same surgeon. The patients were matched according to intraoperative blood loss, age, sex, and number of involved levels. Control patients were managed between 2004 and 2007, whereas study patients were managed between 2008 and 2011. The only variable between the study and control groups was that, in the study group, absorbable gelatin compressed sponge was soaked in thrombin and applied over the exposed spine before wound closure. A subfascial drain was used in all patients. Total drain output, time for the drainage to decrease to <30 mL per eight-hour shift (at which point the drain was discontinued), the length of stay, the number of readmissions, and postoperative complications were analyzed.


Total drain output averaged 93 mL in the study group and 204 mL in the control group (p < 0.0001). The average time for the drainage to decrease to <30 mL per eight-hour shift was 2.5 shifts in the study group and 4.4 shifts in the control group (p < 0.0001). Length of stay averaged 1.3 days (cumulative total, fifty-seven days) in the study group and 2.2 days (cumulative total, ninety-five days) in the control group (p < 0.0001). Persistent drain output was the primary reason preventing discharge on the first postoperative day. There were no infections, epidural hematomas, or readmissions within thirty days of discharge in either group. No patient developed adverse reactions attributable to the thrombin-soaked absorbable gelatin compressed sponge.


Application of thrombin-soaked absorbable gelatin compressed sponge at the end of multilevel posterior cervical spinal surgery significantly decreased postoperative drain output and consequent hospital stay.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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