Objectives: This analysis compared outcomes among patients undergoing cesarean section (c-section) or open hysterectomy that required use of powdered hemostats (oxidized regenerated cellulose [ORC] and microporous polysaccharide [MP]). Methods: C-section and hysterectomy patients were identified in the Premier chargemaster database between 11/2017 and 12/2018. Patients were grouped into cohorts based on the powdered hemostat identified in the billing data; patient characteristics, costs, and ICU stay were reported among each cohort by procedure. Results: 577 ORC and 3,397 MP-related c-section procedures and 260 ORC and 1,402 MP-related hysterectomy procedures were identified. The payer distribution was significantly different between the two c-section cohorts (58% of ORC patients were coved by Medicaid as compared with 44% of MP patients (p,0.005)) but comparable between hysterectomy cohorts. In the c-section cohorts, 27% of ORC patients were reported as obese, compared to 17% among MP patients (p,0.005); the obesity rate was comparable among hysterectomy patients. Among c-section patients, the mean cost per discharge for ORC patients was $9,176 compared to $9,721 for MP patients (p=0.03) and the proportions of patients with an Intensive Care Unit (ICU) stay were 3% and 5%, respectively (p=0.05). For hysterectomy patients, the mean cost per discharge was $10,453 in the ORC cohort and $11,381 in the MP cohort, and the proportions of patients with an ICU stay were 2% and 4%, respectively; neither difference was statistically significant. Conclusions: Mean cost and proportion of patients with an ICU stay were significantly lower in the ORC cohort relative to the MP cohort among c-section procedures. Directionally similar but not statistically significant results were also observed among hysterectomy procedures. Further research is warranted to determine the extent of these differences when controlling for patient and provider characteristics.

Background Posttraumatic lymphedema (PTL) is sparsely described in the literature. The aim of this study is to propose a comprehensive approach for prevention and treatment of PTL using lymphovenous anastomosis (LVA) and lymphatic vessels free flap, reporting our experience in the management of early-stage lymphedema. Methods A retrospective observational study was performed between October 2017 and July 2022. Functional assessment with magnetic resonance lymphangiography and indocyanine green lymphography was performed. Patients with lymphedema and functional lymphatic channels were included. Cases with limited soft tissue damage were proposed for LVA, and those with acute or prior soft tissue damage needing skin reconstruction were proposed for superficial circumflex iliac artery perforator lymphatic vessels free flap (SCIP-LV) to treat or prevent lymphedema. Primary and secondary outcomes were limb volume reduction and quality of life (QoL) improvement, respectively. Follow-up was at least 1 year. Results Twenty-eight patients were operated using this approach during the study period. LVA were performed in 12 patients; mean reduction of excess volume (REV) was 58.82% and the improvement in QoL was 49.25%. SCIP-LV was performed in seven patients with no flap failure; mean REV was 58.77% and the improvement QoL was 50.9%. Nine patients with acute injury in lymphatic critical areas were reconstructed with SCIP-LV as a preventive approach and no lymphedema was detected. Conclusion Our comprehensive approach provides an organized way to treat patients with PTL, or at risk of developing it, to have satisfactory results and improve their QoL.

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