(L) Clinical and Economic Burden Associated with Uncontrolled Surgical Bleeding: A Retrospective Database Analysis

Publication Number: 1011

Background: Hemostatic agents are used to control surgical bleeding, a common intra- and post-operative complication; however, some patients experience uncontrolled bleeding despite the use of hemostats.

Objectives: Among patients receiving hemostats, to compare clinical and economic outcomes between patients with vs. without uncontrolled bleeding during a hospital encounter for selected surgical procedures of interest.

Methods: Retrospective analysis of hospital data from the Premier Healthcare Database. Study patients were age ≥18 years and had a hospital encounter for one of 9 procedures of interest between 1-Jan-2019 and 31-Dec-2019: cholecystectomy, coronary artery bypass grafting (CABG), cystectomy, hepatectomy, hysterectomy, pancreatectomy, peripheral vascular, thoracic, and valve procedures (first procedure = index). Patients were also required to have evidence of hemostatic agent use during index. Patients were grouped by presence vs. absence of uncontrolled bleeding, defined as diagnosis and/or intervention for bleeding during the index encounter despite hemostat use. Outcomes included intensive care unit (ICU) admission and duration, requirement for ventilator, overall length of stay (LOS), and total hospital costs during index. Generalized linear models were used to examine the association of uncontrolled bleeding with the outcomes, adjusting for patient, procedural, and hospital/provider characteristics.

Results: A total of 51,448 were included for study: 64% females; 76% white; mean age of 57 years; 16% had uncontrolled bleeding (range 1.5% for cholecystectomy to 44.4% for valve). In procedures for which ICU and ventilator use is not routine (i.e., excluding CABG and valve), uncontrolled bleeding was associated with significant increases in the risks of admission to ICU (relative risk range 1.21 for peripheral vascular to 4.57 for hysterectomy, all P<.05) and requirement for ventilator (relative risk range 1.78 for cystectomy to 4.91 for hysterectomy, all P<.05). Across all procedures, uncontrolled bleeding was also associated with significant incremental increases in days spent in ICU (range 0.8 days for CABG to 1.6 for cystectomy, all P<.05), overall LOS days (range 0.7 days for thoracic to 6.3 for cholecystectomy, all P<.05 except thoracic), and incremental total hospital costs (range $3,329 for cholecystectomy to $14,762 for valve, all P<.05).

Conclusions: The incidence of uncontrolled bleeding varied by procedure type and was associated with substantial patient clinical and economic burden across a wide variety of surgical procedures. Findings emphasize the need for more effective and timely intervention for surgical bleeding events.