# Pilot Feasibility and Preliminary Cost Implications of a Day-Case Head and Neck Surgery Pathway Incorporating ARTISS Fibrin Sealant

## TL;DR

This study shows that using ARTISS fibrin sealant in a day-case pathway for head and neck surgery is feasible and safe, with potential cost savings in the NHS.

## Contribution

The study introduces a standardized day-case pathway for head and neck surgery using ARTISS fibrin sealant and evaluates its feasibility and cost implications.

## Key findings

- 86.2% of patients were discharged the same day with no returns to the operating room or 30-day readmissions for complications.
- Drains were used in only 3.4% of cases, and base-case modeling suggested cost savings compared to inpatient care.
- The safety profile was favorable, but the study could not isolate the independent effect of ARTISS due to its non-comparative design.

## Abstract

Objective: The objective of this study was to evaluate the feasibility, safety, and preliminary cost implications of implementing a standardized day-case pathway for common head and neck procedures that incorporates ARTISS fibrin sealant (human).

Design: This was a single-center, retrospective pilot service evaluation of consecutive cases.

Setting: The study was conducted at a UK National Health Service (NHS) district general hospital (day surgery unit without inpatient beds).

Participants: Participants included consecutive adults between October 2024 and February 2025 who underwent selected head and neck procedures judged suitable for day-case management under a predefined pathway.

Intervention: A protocolized bundle including meticulous hemostasis, ARTISS applied at closure to promote adhesion and reduce dead space, drain avoidance where feasible (surgeon discretion permitted), structured recovery and explicit discharge criteria, and written or telephone safety-netting.

Main outcome measures: The primary outcome was same-day discharge, and the secondary outcomes included unplanned overnight admission, return to the operating room, 30-day readmission, hematoma or seroma, drain use, and other adverse events. A provider-perspective cost-consequence analysis compared day-case delivery with procedure-specific inpatient length of stay (LOS) estimates from the literature, and one-way sensitivity analyses were performed varying LOS, bed-day costs, and ARTISS price.

Results: Twenty-nine patients underwent day-case head and neck surgery; 25/29 (86.2%; 95% CI 69.4-94.5) were discharged the same day. No returns to the operating room or 30-day readmissions for hemorrhage or seroma were observed (95% upper bound 10.3%). Drains were used in 1/29 (3.4%; 95% CI 0.6-17.2). Base-case modeling indicated bed-day cost savings versus inpatient care.

Conclusions: A standardized day-case pathway that incorporates ARTISS was feasible in this retrospective pilot, with a preliminary favorable safety profile and cost consequences in an NHS setting. As a single-center, non-comparative study, findings are preliminary and cannot isolate the independent effect of ARTISS. Future studies should include multicenter comparative evaluation (ARTISS versus no ARTISS within the same pathway) and formal economic analysis.