Association of In-Hospital Surgical Bleeding Events with Prolonged Hospital Length of Stay, Days Spent in Critical Care, Complications, and Mortality: A Retrospective Cohort Study Among Patients Undergoing Neoplasm-Directed Surgeries in English Hospitals

Johnston, Stephen S.; Jamous, N.; Mistry, Sameer; Jain, Simran; Gangoli, Gaurav; Danker, Walter; Ammann, Eric M.; Hampton, K. K.

doi:10.2147/ceor.s287970

Cited by 5 publications

(8 citation statements)

References 26 publications

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“…Transfusion-associated complications during the index encounter were defined by the presence of ICD-10-CM diagnosis codes indicating infection, acute renal failure, or specific vascular events. 3 The total hospital cost (ie, costs borne by the hospital) and length of stay for the index encounter were also assessed.…”

Section: Data Source and Study Populationmentioning

confidence: 99%

“…1 Surgery-related disruptive bleeding confers clinical burden through increased morbidity and mortality, and adds economic burden through increased use of expensive healthcare services (eg, critical/intensive care unit [CCU/ICU] admissions, extended operating room times), longer hospital stays, and greater need for repeat procedures, all of which contribute to higher all-cause direct healthcare costs. [2][3][4][5] The nature of the surgical procedure and particular patient characteristics (eg, age, bleeding history, medication exposures) influence a given patient's risk of intra-or post-operative bleeding, but the understanding of these risk factors is currently incomplete and still evolving. For instance, even as recently as 2018, the American College of Surgeons noted in its Guidelines for the Perioperative Management of Antithrombotic Medication that physicians should rely on their own experience to judge procedure-specific bleeding risk, with consideration for both the invasiveness of the procedure and the potential consequences if bleeding should occur.…”

Section: Introductionmentioning

confidence: 99%

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Increasing Incremental Burden of Surgical Bleeding Associated with Multiple Comorbidities as Measured by the Elixhauser Comorbidity Index: A Retrospective Database Analysis

Afolabi,

Johnston,

Tewari

et al. 2023

MDER

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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), transfusionassociated 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,). 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.

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Section: Data Source and Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increasing Incremental Burden of Surgical Bleeding Associated with Multiple Comorbidities as Measured by the Elixhauser Comorbidity Index: A Retrospective Database Analysis

Afolabi,

Johnston,

Tewari

et al. 2023

MDER

Self Cite

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“…In particular, traumatic and surgical bleeding are life-threating but potentially avoidable causes of death [ 9 , 10 ]. Johnston et al showed that postsurgical bleeding is associated with substantial increases in postprocedural length of stay, days spent in critical care, and the risks of infection, vascular events, acute renal failure, and in-hospital mortality [ 11 ]. In addition, use of anticoagulants and antiplatelets increases the surgical bleeding risk, creates a need for multiple pharmacologic approaches and poses potential problems in managing surgical patients [ 12 - 15 ].…”

Section: To the Editormentioning

confidence: 99%

Unveiling the Great Therapeutic Potential of MASPs as Hemostatic Agents

Saad

2022

J Hematol

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“… 1 , 2 Uncontrolled surgical bleeding is responsible for a substantial clinical and health care resource utilization burden, specifically given population aging and the associated increased prevalence of comorbidities and increased use of anticoagulants. 3 – 7 By facilitating hemostasis in situations of mild-to-moderate bleeding where conventional hemostatic measures are insufficient or impractical, the adjunctive use of topical hemostatic agents reduces blood loss and the need for systemic hemostatic drugs and blood transfusions. By reducing surgical time and surgical complications, they ultimately optimize patient health and reduce health care costs.…”

Section: Introductionmentioning

confidence: 99%

Safety and Hemostatic Effectiveness of SURGICEL® Powder in Mild and Moderate Intraoperative Bleeding

Al‐Attar

Jonge

Kocharian³

et al. 2023

Clin Appl Thromb Hemost

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This postmarket clinical study evaluated the safety and effectiveness of the novel adjunctive topical hemostat SURGICEL® Powder (SURGICEL®-P), a powdered form of oxidized regenerated cellulose. In a prospective, open-label, single-arm multicenter trial, adult surgical subjects with mild-to-moderate bleeding for which conventional hemostatic methods were impractical/ineffective were treated with SURGICEL®-P. Descriptive analyses included hemostatic success rate at 3, 5, and 10 min, rebleeding and thromboembolic events, SURGICEL®-P-related serious adverse events requiring surgical intervention, and SURGICEL®-P ease of use (questionnaire). In 8 centers, 103 subjects were enrolled with a median (range) age of 64.0 (33.0-88.0) years. Surgeries were open (53.4%) or laparoscopic/thoracoscopic (46.6%) and mostly urological (37.9%) and abdominal (32.0%) procedures. Bleeding sites included various tissue types, with a median (range) surface area of 4 (0.02-72.0) cm2. Hemostatic success rates were 77.7%, 87.4%, and 92.2% at 3, 5, and 10 min, respectively. In 7 subjects (6.8%), investigators reverted to standard of care. No safety signals were identified. Two deaths occurred with causes unrelated to SURGICEL®-P. Investigators favorably evaluated the ease of use of the SURGICEL®-P device. SURGICEL®-P is safe and effective in controlling mild-to-moderate bleeding in a broad range of surgical procedures. The trial was registered at https://clinicaltrials.gov as NCT03762200.

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Association of In-Hospital Surgical Bleeding Events with Prolonged Hospital Length of Stay, Days Spent in Critical Care, Complications, and Mortality: A Retrospective Cohort Study Among Patients Undergoing Neoplasm-Directed Surgeries in English Hospitals

Cited by 5 publications

References 26 publications

Increasing Incremental Burden of Surgical Bleeding Associated with Multiple Comorbidities as Measured by the Elixhauser Comorbidity Index: A Retrospective Database Analysis

Increasing Incremental Burden of Surgical Bleeding Associated with Multiple Comorbidities as Measured by the Elixhauser Comorbidity Index: A Retrospective Database Analysis

Unveiling the Great Therapeutic Potential of MASPs as Hemostatic Agents

Safety and Hemostatic Effectiveness of SURGICEL® Powder in Mild and Moderate Intraoperative Bleeding

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