Santosh J Agarwal, BPharm MS, Alexandra A MacLean, MD, Gary V Delhougne, JD MHA, Ned Cosgriff, MD, Ross D Segan, MD FACS. Covidien
Objective: The objective of this study was to examine the incidence of blood transfusion in selected open and laparoscopic abdominal surgical procedures and evaluate the impact of transfusion on hospitalization costs and length of hospital stay.
Methods: The Premier PerspectiveTM Database (PPD) was used to identify open and laparoscopic appendectomy, cholecystectomy, colectomy and Roux-en-Y gastric bypass surgical procedures in 2009. PPD is the largest hospital-based comparative database providing detailed resource utilization and cost data. Combinations of ICD9 and CPTTM codes were used to identify patients with blood transfusion(s). We compared the incidence of blood transfusion, mortality rates, total hospitalization costs and hospital length of stay (LOS) among selected open and laparoscopic procedures. Multivariate regression analysis was used to predict the total costs and length of stay, controlling for age, race, sex, geographic region, urban areas, teaching hospitals, bed size, APR severity, Charlson comorbidity index, malignant diagnosis, operating room time and blood transfusion.
Results: A total of 129,638 discharges (71.1% laparoscopic) with selected abdominal surgeries were included in the analysis. There were 34,972 appendectomies (73.9% laparoscopic), 51,936 cholecystectomies (88.9% laparoscopic), 31,768 colectomies (33.8% laparoscopic) and 10,962 Roux-en-Y’s (85.8% laparoscopic). Blood transfusion was reported in 3.4% of the laparoscopic cases and 17.5% of open cases (p <0.0001). Mortality rates were significantly higher among those with blood transfusion compared to those without, for both open and laparoscopic procedures. Table 1 describes the clinical and economic outcomes of laparoscopic and open procedures, with and without blood transfusion. After risk adjustment, patients with blood transfusion had an incremental mean cost of $6,495 for laparoscopic procedures (p<0.0001) and $10,804 for open procedures (p<0.0001). After risk adjustment, patients with blood transfusion had an incremental mean LOS of 2.9 days for laparoscopic procedures (p<0.0001) and 3.4 days for open procedures (p<0.0001).
Table1: Clinical and economic outcomes of laparoscopic and open procedures, with and without blood transfusion.*
|Mortality Rate (%)||0.2%||3.1%||1.9%||9.9%|
|Mean total cost||$9,717||$26,764||$16,002||$39,882|
|Mean LOS in days||3.3||10.9||7.1||15.8|
|Adjusted mean total cost (95% CI)||$18,252
|Adjusted mean LOS in days (95% CI)||6.5
*Costs were discounted to December 2009 value.
Conclusion: This study demonstrates the increased incidence of blood transfusion in open cases compared to laparoscopic cases. Patients with blood transfusion had higher mortality rates, increased hospital length of stay and subsequent hospital costs. This study confirms the increased economic burden associated with blood transfusion in selected abdominal surgeries. Development and adoption of interventional strategies that reduce the need for blood transfusion should be explored.
Program Number: P464