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Increasing Incremental Burden of Surgical Bleeding Associated with Multiple Comorbidities as Measured by the
Mosadoluwa Afolabi1, Stephen S Johnston1, Pranjal Tewari2
1MedTech Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, NJ, USA.
Insights
Higher comorbidity increases surgical bleeding risk, transfusion complications, and costs. This study quantifies these risks in over 300,000 patients, highlighting the impact of multiple health conditions on surgical outcomes.
Area of Science:
- Surgical Outcomes Research
- Health Economics
- Patient Safety
Background:
- Disruptive bleeding is a significant complication in surgical procedures.
- It leads to increased resource utilization and adverse patient outcomes.
- Understanding the influence of patient comorbidities is crucial for risk assessment.
Purpose of the Study:
- To determine the impact of comorbidity on surgical bleeding risk.
- To assess the association between comorbidity and transfusion-associated complications.
- To quantify the incremental cost of bleeding in relation to comorbidity burden.
Main Methods:
- Retrospective analysis of the Premier Healthcare Database (2019).
- Inclusion of adult patients undergoing specific surgical procedures (e.g., cholecystectomy, CABG, hysterectomy).
- Utilized the Elixhauser comorbidity index and multivariable generalized linear models.
Main Results:
- 7% of 304,074 patients experienced bleeding.
- Increased Elixhauser comorbidity scores significantly correlated with higher odds of bleeding (OR=3.22 for ≥6 comorbidities vs 0).
- Higher comorbidity also increased transfusion complications (OR=12.37 for ≥6 vs 0) and incremental costs.
Conclusions:
- Elevated comorbidity burden significantly elevates the risk of surgical bleeding.
- Comorbidities are linked to increased transfusion-related complications.
- Managing comorbidities is essential to mitigate bleeding risks and associated healthcare costs.
Purpose:
Disruptive bleeding can complicate surgical procedures, increasing resource use, and impacting patients' well-being. This study aims to elucidate the impact of comorbidity on the risk of disruptive surgical-related bleeding and selected transfusion-associated complications, as well as the incremental cost of such bleeding.
Patients And Methods:
This retrospective analysis of the Premier Healthcare Database included patients who were age ≥18 years and who had a procedure of interest between 1-Jan-2019-31-Dec-2019: cholecystectomy, coronary artery bypass grafting, cystectomy, hepatectomy, hysterectomy, pancreatectomy, peripheral vascular, thoracic, and valve procedures (first=index). The Elixhauser comorbidity index was assessed on index date and patients were grouped by cumulative comorbidity score (0, 1, 2, 3, 4, 5, ≥6). Outcomes, all measured as in-hospital during index, included bleeding (diagnosis and/or intervention for bleeding), transfusion-associated complications (diagnosis of infection, acute renal failure, or vascular events), and incremental total hospital costs associated with bleeding. Multivariable generalized linear models were used to examine the association of comorbidity/bleeding with outcomes.
Results:
Of the 304,074 patients included, 7% experienced bleeding. The Elixhauser scores were distributed as follows: 0=29%, 1=23%, 2=18%, 3=12%, 4=8%, 5=5%, ≥6=5%. Odds of bleeding significantly increased with Elixhauser score: 1 comorbidity vs 0 (odds ratio [OR] =1.30, 95% confidence interval [95% CI] =1.19-1.43), and this trend continued to surge (≥6 comorbidities [OR=3.22, 95% CI=2.94-3.53]). Similarly, the odds of transfusion-associated complications significantly increased with comorbidities score: 1 comorbidity vs 0 (OR=2.14, 95% CI=1.88-2.34), ≥6 comorbidities vs 0 (OR=12.37, 95% CI=10.80-14.16). The incremental cost of bleeding also increased with comorbidities score; per-patient costs with and without bleeding were $18,132 vs $13,190, p < 0.001 among patients with 0 comorbidities and $28,952 vs $19,623, p < 0.001 among patients with ≥6 comorbidities.
Conclusion:
Higher comorbidity burden was associated with significant increases in the risk of surgical bleeding, subsequent transfusion-related complications, and incremental cost burden of bleeding.
