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Cost of Bleeding in Trauma and Complex Cardiac Surgery
1CSL Behring, King of Prussia, Pennsylvania.
Insights
Patients experiencing bleeding after trauma or cardiac surgery incur significantly higher healthcare costs and longer hospital stays. This highlights the economic burden of bleeding complications in critical care settings.
Area of Science:
- Healthcare economics
- Surgical outcomes
- Trauma care
Background:
- Trauma and complex cardiac surgery carry a high risk of bleeding complications.
- The economic impact of bleeding in these patient populations is not well understood.
Purpose of the Study:
- To assess the cost of care and patient outcomes for trauma and complex cardiac surgery patients who experienced bleeding complications.
- To compare the healthcare costs and length of stay for bleeding versus non-bleeding patients.
Main Methods:
- Retrospective analysis of adult patients discharged between January 2010 and December 2012 using the Premier Hospital Database.
- Patients were categorized as 'bleeding' (received blood products) or 'nonbleeding'.
- Univariate and multivariate analyses were used to compare costs and outcomes, excluding patients with zero cost or length of stay.
Main Results:
- Bleeding trauma patients had 150% higher total costs and 81.3% longer hospital stays than non-bleeding patients.
- Bleeding complex cardiac surgery patients had 133.2% higher total costs and 155.6% longer hospital stays than non-bleeding patients.
- Increased length of stay in intensive care units (ICU) was observed in both bleeding trauma (65.2%) and cardiac surgery (89.3%) patients.
Conclusions:
- Patients undergoing trauma or cardiac surgery who experience bleeding and receive blood transfusions have significantly worse outcomes.
- These outcomes include longer lengths of stay, increased inpatient mortality, and higher healthcare costs.
- The elevated costs associated with bleeding complications persist even when excluding the direct costs of bleeding control agents.
Purpose:
Trauma and complex cardiac surgery are associated with a high risk of bleeding complications. The difference in costs between patients who require bleeding control measures and those who do not is poorly understood. Our goal was to assess the cost of care and outcomes for patients in these settings.
Methods:
Patients >18 years of age, who were discharged between January 2010 and December 2012, were retrospectively identified in the Premier Hospital Database based on International Classification of Disease, Ninth Revision codes. These patients were categorized as having received blood products ("bleeding patients") or not ("nonbleeding patients"). Patients with costs and length of stay (LOS) of zero were excluded. Differences in treatment costs and outcomes were assessed using univariate analysis and multivariate modeling.
Findings:
Bleeding trauma patients (n = 8800) had a 150% higher total cost of care (P < 0.001; 146% after excluding costs of agents used for bleeding control, P < 0.001), an 81.3% longer hospital LOS (P < 0.001), and a 65.2% longer intensive care unit (ICU) LOS (P < 0.001) than nonbleeding patients (n = 53,727). Bleeding complex cardiac surgery patients (n = 82,832) had a 133.2% higher total cost of care (P < 0.001; 128.7% after excluding costs of agents used for bleeding control, P < 0.001), a 155.6% longer hospital LOS (P < 0.001), and an 89.3% longer ICU LOS (P < 0.001) than nonbleeding patients (n = 380,902).
Implications:
Trauma and cardiac surgery patients who experienced bleeding and received allogeneic blood product transfusions had significantly worse outcomes, including longer LOS, greater inpatient mortality, and higher costs of care (even when excluding costs of agents used for bleeding control) than those who did not.
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