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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 8/2019

01-08-2019 | Anemia | Reports of Original Investigations

Hospital cost associated with anemia in elective colorectal surgery: a historical cohort study

Authors: Simon Feng, MD, Joshua Greenberg, MD, MSc, Husein Moloo, MD, MSc, Kednapa Thavorn, PhD, Daniel I. McIsaac, MD, MPH

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 8/2019

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Abstract

Purpose

Anemia is highly prevalent in the colorectal surgery population, affecting 30–70% of patients. Anemia is associated with significant morbidity and mortality; however, there is a lack of evidence on how much anemia impacts healthcare costs. This study aims to determine the hospital cost of index surgical admission, postoperative length of stay, and transfusion rate associated with preoperative anemia in elective major colorectal surgery.

Methods

This historical cohort study included 851 adult inpatients having elective colorectal surgery at a tertiary care academic health sciences network between April 2010 and February 2016. Anemia was defined as hematocrit ≤ 39%. The primary outcome was total hospital costs standardized to 2016 CAD. Secondary outcomes were postoperative length of stay and transfusion. Multivariable regression analyses and propensity score methods were used to measure adjusted associations between anemia and outcomes.

Results

Before surgery, 381/851 (45%) patients were anemic. The mean (standard deviation [SD]) cost of index admission for an elective colorectal surgery was 20,040 (23,219) CAD. Anemia was associated with an adjusted 14% relative increase in costs (95% confidence interval [CI], 6 to 23; P < 0.001). The total hospitalization cost attributable to anemia was 3,027 CAD (95% CI, 2,670 to 3,388). Hospital costs and length of stay were highly associated; anemia was associated with an 18% increase in length of stay (95% CI, 7 to 30; P < 0.001) and increased transfusion rates (risk ratio, 4.7; 95% CI, 2.71 to 8.33; P < 0.001).

Conclusion

Over 2,600 CAD per index surgical admission is attributable to preoperative anemia. Preoperative interventions with per patient cost of less than 2,600 CAD could be cost effective at the hospital level.

Trial registration

www.​clinicaltrials.​gov (NCT03476707); registered 26 March, 2018.
Appendix
Available only for authorised users
Literature
1.
Muñoz M, Gómez-Ramírez S, Martín-Montañez E, Auerbach M. Perioperative anemia management in colorectal cancer patients: a pragmatic approach. World J Gastroenterol 2014; 20: 1972-85.CrossRefPubMedPubMedCentral
2.
Aydinli HH, Benlice C, Ozuner G, Gorgun E, Abbas MA. Risk factors associated with postoperative morbidity in over 500 colovesical fistula patients undergoing colorectal surgery: a retrospective cohort study from ACS-NSQIP database. Int J Colorectal Dis 2017; 32: 469-74.CrossRefPubMed
3.
Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK. Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg 2011; 212: 187-94.CrossRefPubMed
4.
Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet 2011; 378: 1396-407.CrossRefPubMed
5.
Beattie WS, Karkouti K, Wijeysundera DN, Tait G. Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology 2009; 110: 574-81.CrossRefPubMed
6.
Wu WC, Schifftner TL, Henderson WG, et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. JAMA 2014; 297: 2481-8.CrossRef
7.
Vonlanthen R, Slankamenac K, Breitenstein S, et al. The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg 2011; 254: 907-13.CrossRefPubMed
8.
Feng S, Machina M, Beattie WS. Influence of anaemia and red blood cell transfusion on mortality in high cardiac risk patients undergoing major non-cardiac surgery: a retrospective cohort study. Br J Anaesth 2017; 118: 843-51.CrossRefPubMed
9.
Lagerquist O, Poseluzny D, Werstiuk G, et al. The cost of transfusing a unit of red blood cells: a costing model for Canadian hospital use. ISBT Sci Ser 2017; 12: 375-80.CrossRef
10.
Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery:aA systematic review and meta-analysis. Ann Surg 2012; 256: 235-44.CrossRefPubMed
11.
Talukder Y, Stillwell AP, Siu SK, Ho YH. Comparing survival and recurrence in curative stage I to III colorectal cancer in transfused and nontransfused patients. Int Surg 2014; 99: 8-16.CrossRefPubMedPubMedCentral
12.
Kulik U, Schrem H, Bektas H, Klempnauer J, Lehner F. Prognostic relevance of hematological profile before resection for colorectal liver metastases. J Surg Res 2016; 206: 498-506.CrossRefPubMed
13.
Muñoz M, Gõmez-Ramírez S, Cuenca J, et al. Very-short-term perioperative intravenous iron administration and postoperative outcome in major orthopedic surgery: a pooled analysis of observational data from 2547 patients. Transfusion 2014; 54: 289-99.PubMed
14.
Schröder O, Mickisch O, Seidler U, et al. Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease–a randomized, controlled, open-label, multicenter study. Am J Gastroenterol 2005; 100: 2503-9.CrossRefPubMed
15.
Lidder PG, Sanders G, Whitehead E, et al. Pre-operative oral iron supplementation reduces blood transfusion in colorectal surgery - a prospective, randomised, controlled trial. Ann R Coll Surg Engl 2007; 89: 418-21.CrossRefPubMedPubMedCentral
16.
Pujol-Nicolas A, Morrison R, Casson C, et al. Preoperative screening and intervention for mild anemia with low iron stores in elective hip and knee arthroplasty. Transfusion 2017; 57: 3049-57.CrossRefPubMed
17.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-7.CrossRef
18.
Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med 2015; 12: e1001885.CrossRefPubMedPubMedCentral
19.
McIsaac DI, Abdulla K, Yang H, et al. Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score-matched observational cohort study. CMAJ 2017; 189: E905-12.CrossRefPubMedPubMedCentral
20.
21.
Austin PC. Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat Simul Comput 2009; 38: 1228-34.CrossRef
22.
Austin PC, Ghali WA, Tu JV. A comparison of several regression models for analysing cost of CABG surgery. Stat Med 2003; 22: 2799-815.CrossRefPubMed
23.
Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013; 217: 833-42.e1-3.
24.
Sauerbrei W, Royston P. Building multivariable prognostic and diagnostic models: transformation of the predictors by using fractional polynomials. J R Stat Soc Ser A 1999; 162: 71-94.CrossRef
25.
Austin PC, Rothwell DM, Tu JV. A comparison of statistical modeling strategies for analyzing length of stay after CABG surgery. Health Serv Outcomes Res Methodol 2002; 3: 107-33.CrossRef
26.
Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015; 34: 3661-79.CrossRefPubMedPubMedCentral
27.
Austin PC, Steyerberg EW. The number of subjects per variable required in linear regression analyses. J Clin Epidemiol 2015; 68: 627-36.CrossRefPubMed
28.
Sterne JA, White IR, Carlin JB, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009; 338: b2393.CrossRefPubMedPubMedCentral
29.
Frew N, Alexander D, Hood J, Acornley A. Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty. Ann R Coll Surg Engl 2016; 98: 380-6.CrossRefPubMedPubMedCentral
30.
Schilling PL, Dimick JB, Birkmeyer JD. Prioritizing quality improvement in general surgery. J Am Coll Surg 2008; 207: 698-704.CrossRefPubMed
31.
Thiele RH, Rea KM, Turrentine FE, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg 2015; 220: 430-43.CrossRefPubMed
32.
Keenan JE, Speicher PJ, Thacker JK, Walter M, Kuchibhatla M, Mantyh CR. The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care savings. JAMA Surg 2014; 149: 1045-52.CrossRefPubMed
33.
Gani F, Hundt J, Daniel M, Efron JE, Makary MA, Pawlik TM. Variations in hospitals costs for surgical procedures: inefficient care or sick patients? Am J Surg 2017; 213: 1-9.CrossRefPubMed
34.
Potter LJ, Doleman B, Moppett IK. A systematic review of pre-operative anaemia and blood transfusion in patients with fractured hips. Anaesthesia 2015; 70: 483-500.CrossRefPubMed
35.
Wong CJ, Vandervoort MK, Vandervoort SL, et al. A cluster-randomized controlled trial of a blood conservation algorithm in patients undergoing total hip joint arthroplasty. Transfusion 2007; 47: 832-41.CrossRefPubMed
36.
37.
Doumouras AG, Saleh F, Tarride JE, Hong D. A population-based analysis of the drivers of short-term costs after bariatric surgery within a publicly funded regionalized center of excellence system. Surg Obes Relat Dis 2015; 12: 1023-31.CrossRef
38.
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 2014; 38: 1531-41.CrossRefPubMed
39.
Wilson MJ, Dekker JW, Harlaar JJ, Jeekel J, Schipperus M, Zwaginga JJ. The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment. Int J Colorectal Dis 2017; 32: 1617-24.CrossRefPubMedPubMedCentral
40.
Steensma DP, Sloan JA, Dakhil SR, et al. Phase III, randomized study of the effects of parenteral iron, oral iron, or no iron supplementation on the erythropoietic response to darbepoetin alfa for patients with chemotherapy-associated anemia. J Clin Oncol 2011; 29: 97-105.CrossRefPubMed
41.
42.
Kotzé A, Carter LA, Scally AJ. Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle. Br J Anaesth 2012; 108: 943-52.CrossRefPubMed
43.
Richards T, Clevenger B, Keidan J, et al. PREVENTT: preoperative intravenous iron to treat anaemia in major surgery: study protocol for a randomised controlled trial. Trials 2015; 16: 254.CrossRefPubMedPubMedCentral
Metadata
Title
Hospital cost associated with anemia in elective colorectal surgery: a historical cohort study
Authors
Simon Feng, MD
Joshua Greenberg, MD, MSc
Husein Moloo, MD, MSc
Kednapa Thavorn, PhD
Daniel I. McIsaac, MD, MPH
Publication date
01-08-2019
Publisher
Springer International Publishing
Keyword
Anemia
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 8/2019
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-019-01379-8

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