Safety and Efficacy of Flowable Gelatin Hemostatic Matrix Sealants in Spine Surgery: A Systematic Review and Meta-Analysis

Study Design: A systematic review and meta-analysis. Objective: To evaluate the safety and efficacy of flowable gelatin hemostatic matrix (FGHM), particularly Floseal and Surgiflo, in achieving effective hemostasis in spine surgery. Summary of Background Data: Achieving effective hemostasis during spine surgery is paramount, as uncontrolled bleeding can impair visualization and increase perioperative mortality and morbidity. Conventional hemostatic methods (CHMs) may be inadequate or impractical in certain settings, especially in minimally invasive approaches. Materials and Methods: PubMed, Medline, Scopus, Embase, Web of Science, and the Cochrane Library databases were searched comprehensively to identify potentially eligible studies. Based on statistical heterogeneity, either a fixed-effect or random-effect model was used. Heterogeneity was evaluated through subgroup and sensitivity analyses. To account for potential covariates, meta-regression analyses were performed. Results: FGHM use was associated with significantly lower perioperative transfusion risk (OR: 0.36; 95% CI: 0.16–0.81; I 2 =0%; P =0.03), postoperative drainage volume (SMD: −0.46; 95% CI: −0.84 to −0.07; I 2 =88.36%; P =0.02), postoperative length of hospital stay (SMD: −0.38; 95% CI: −0.52 to −0.24; I 2 =0%; P =0.0034), and complication rate (OR: 0.36; 95% CI: 0.20–0.66; I 2 =0%; P =0.0061). Intraoperative blood loss (SMD: −0.64; 95% CI: −1.56 to 0.28; I 2 = 95%), total blood loss (SMD: −0.36; 95% CI: −0.93 to 0.20; I 2 = 0%; P = 0.11), operation duration (SMD: −0.06; 95% CI: −0.36 to 0.23; I 2 =79.20%; P =0.65), reoperation rate (OR: 0.30; 95% CI: 0.07–1.27; I 2 =0%; P =0.07), and overall length of hospital stay (SMD: −0.27; 95% CI: −0.59 to 0.05; I 2 =62%; P =0.09) did not show statistically significant reductions. Floseal and Surgiflo with thrombin showed comparable transfusion risk, operation duration, overall length of hospital stays, and complication rates. Conclusions: FGHM can be used as a safe adjunct to CHMs in achieving efficient hemostasis during spine surgery. Although its use was not associated with significant blood loss reduction, its use is most beneficial in settings where CHMs are insufficient or impractical. Floseal and Surgiflo showed equivalent clinical outcomes. Further randomized controlled trials are warranted to investigate the independent value of FGHM, especially in complex spine procedures.