Comparative Study of Topical Haemostatic Agents in Surgical Practice: Oxidized Regenerated Cellulose, Gelatin-Based Sponge and Haemocoagulase versus Conventional Methods

Abstract

Background: Topical haemostatic agents are widely used adjuncts to conventional mechanical and thermal techniques for achieving intraoperative haemostasis, particularly in high-risk or difficult-to-access surgical fields. Oxidized regenerated cellulose (ORC), gelatin-based sponge and haemocoagulase are among the agents commonly used, but comparative clinical data on their relative efficacy and safety remain limited. Objectives: To compare the effectiveness of ORC, gelatin-based sponge and haemocoagulase against conventional haemostatic methods, and to assess their relative cost-effectiveness in routine surgical practice. Methods: This prospective comparative study included 240 adult patients undergoing elective breast, kidney, liver, prostate, splenic or thyroid surgery at Hamidia Hospital, Bhopal, between July 2010 and August 2015. Patients were allocated to six surgery-based groups of 40 each, further divided into four subgroups of 10 according to the haemostatic method used (conventional, haemocoagulase, ORC, gelatin-based sponge). Outcomes assessed were time to haemostasis, nature and volume of postoperative drain collection over five days, postoperative blood transfusion requirement, wound infection and abdominal sepsis. Data were analysed using two-factor and one-factor ANOVA, chi-square test and unpaired t-test, with p<0.05 considered significant. Results: ORC achieved haemostasis fastest (mean 75.5–92.4 minutes to a clear drain trend by day 3–5, and 1–2 minutes to primary haemostasis in all 60 patients), significantly faster than gelatin-based sponge, haemocoagulase and conventional methods (unpaired t-test, p<0.001 for all comparisons). The proportion of patients with a clear (non-haemorrhagic) drain was consistently higher in the ORC group from day 1 onward and reached 56/60 (93%) by day 5, compared with 40/60 (67%), 38/60 (63%) and 17/60 (28%) in the gelatin, haemocoagulase and conventional groups respectively (χ² p<0.0001 for days 2–5). Blood transfusion was required in 3/60 (5%) ORC patients versus 8/60 (13.3%), 10/60 (16.6%) and 14/60 (23.3%) in the gelatin, haemocoagulase and conventional groups (χ²=8.40, p=0.0385). Wound infection occurred in 1/60 (1.6%) ORC patients versus 12/60 (20%), 10/60 (16.6%) and 14/60 (23.3%) respectively (χ²=12.62, p=0.0055). Among patients undergoing splenectomy or liver-injury surgery, no patient in the ORC subgroup developed abdominal sepsis, compared with 2/20, 3/20 and 7/20 in the gelatin, haemocoagulase and conventional subgroups (χ²=10.20, p=0.017). Conclusion: Oxidized regenerated cellulose provided faster and more effective haemostasis than gelatin-based sponge, haemocoagulase and conventional methods, with lower rates of postoperative drain collection, transfusion requirement, wound infection and abdominal sepsis. Although ORC costs more than the alternatives, its clinical benefits support its use as a preferred first-line topical haemostatic agent, particularly in high-risk solid-organ and vascular surgery, while cost remains a relevant consideration in resource-limited settings.

Keywords: haemostasis; oxidized regenerated cellulose; gelatin sponge; haemocoagulase; topical haemostatic agents; surgical bleeding