Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA)

Abstract

Background Total knee arthroplasty are among the most frequently conducted surgeries, due to an aging society. Since hospital costs are subsequently rising, adequate preparation of patients and reimbursement becomes more and more important. Recent literature revealed anemia as a risk factor for enhanced length of stay (LOS) and complications. This study analyzed whether preoperative hemoglobin (Hb) and postoperative Hb were associated with total hospital costs and general ward costs. Methods The study comprised 367 patients from a single high-volume hospital in Germany. Hospital costs were calculated with standardized cost accounting methods. Generalized linear models were applied to account for confounders, such as age, comorbidities, body mass index, insurance status, health-related quality of life, implant types, incision-suture-time and tranexamic acid. Results Preoperative anemic women had 426 Euros higher general ward costs (p < 0.01), due to increased LOS. For men, 1 g/dl less Hb loss between the preoperative value and the value before discharge reduced total costs by 292 Euros (p < 0.001) and 161 Euros fewer general ward costs (p < 0.001). Total hospital costs were reduced by 144 Euros with 1 g/dl higher Hb on day 2 postoperatively for women (p < 0.01). Conclusion Preoperative anemia was associated with increased general ward costs for women and Hb loss with decreasing total hospital costs for men and women. Cost containment, especially reduced utilization of the general ward, may be feasible with the correction of anemia for women. Postoperative Hb values may be a factor for adjustments of reimbursement systems. Level of evidence Retrospective cohort study, III.

Associations of preoperative anaemia with healthcare resource use and outcomes after colorectal surgery: a population-based cohort study

“…Anaemia in colorectal surgery is more prevalent with higher attributable costs than in other surgical populations including orthopaedic (12% prevalence, €426 or ∼$600 CAD in total joint arthroplasty) and gynaecologic (23% prevalence, $865 CAD in hysterectomy) surgery. 32 , 33 , 34 Although hysterectomies are limited to biologically female individuals only, the observed higher costs in colorectal surgery do not appear to be related to sex differences, as our analyses did not identify sex as an effect modifier. Instead, the higher cost difference in colorectal surgery may be attributable to the inclusion of complex cancer cases and the greater physiologic stress of colorectal surgery leading to higher rates of postoperative complications.…”