Passive, Active, or Both-What Hemostats Do Surgeons Choose in the Real World, and Should We Rethink It?

Abstract

Background: This study evaluates the association between the type of topical haemostatic agents used during surgery-categorized as active, passive, or a combination of both-and their relationship with intraoperative blood loss and bleeding-related postoperative outcomes.

Methods: A retrospective analysis was conducted at Cooper Health System, Camden, New Jersey, US, using patient records to compare the clinical performance of three haemostatic strategies: active agents, passive agents, and a combined approach.

Results: A total of 149 patients were included in the analysis: 51 treated with passive agents, 51 with active agents, and 47 with both. The mean age at admission was 55.9 years (SD ±16.3). General surgery was the most frequently represented specialty (24.8%), followed by spine (22.1%), neurosurgery (16.8%), and solid organ procedures (16.1%). The combination group showed the highest estimated blood loss (EBL) at 521.3 mL (SD ±1456.83; 95% CI: 93.5-949.0), compared to 390.7 mL (SD ±1004.81; CI: 108.1-673.3) in the active group and 301.5 mL (SD ±295.78; CI: 218.3-384.7) in the passive group. However, ANCOVA results showed no statistically significant difference in adjusted mean EBL between groups (p = 0.309). Notably, patients in the combination group experienced longer operative times, extended ICU stays, and higher mortality.

Conclusion: Numerical trends suggest greater bleeding and more complex postoperative courses in patients treated with the combination of active and passive haemostats. The use of standardized, validated measures of intraoperative bleeding, paired with a strategic approach that anticipates and manages bleeding complications, may support improved clinical outcomes.