Resource utilization and costs of blood management services associated with knee and hip surgeries in US hospitals

Abstract

This article assesses the use and costs of blood transfusion during knee and hip surgery through a retrospective observational study of 92,223 discharged inpatients who had undergone knee or hip surgery from July 1, 2003, through June 30, 2004; a sample of US hospitals that participated in the Perspective Comparative Database (Premier Inc., Charlotte, NC) was used. Descriptive and multivariate analyses were performed to determine the use and costs of allogeneic blood transfusion (ABT). The average cost of ABT per user ranged from $387 (SD=$952) for red blood cells to $6585 (SD=$11,162) for cryoprecipitate. Utilization rates in the sample were as follows: antifibrinolytics, 0.14%; topical sealants, 3.24%; volume expanders, 3.89%; erythropoietin agents, 5.08%; and hypotensive anesthesia, 22.28%. Patients who were given volume expanders ($133.73, SD=$23.00, P<.01) or erythropoietin ($177.72, SD=$34.61, P<.01) had higher costs associated with ABT than did those who did not use volume expanders or erythropoietin. Patients who received hypotensive anesthesia (odds ratio [OR]=1.96; 95% confidence interval [CI], 1.87-2.06), a volume expander (OR=1.71; 95% CI, 1.57- 1.85), a topical sealant (OR=1.61; 95% CI, 1.45-1.79), or an erythropoietic agent (OR=2.30; 95% CI, 2.06-2.57) had a greater likelihood of ABT. Investigators concluded that most transfusion reduction techniques are underused, or they do not reduce the burden of ABT associated with knee or hip surgery.

Utilization of Critical Care Services among Patients Undergoing Total Hip and Knee Arthroplasty

“…Confidence in the validity of information provided by Premier Inc. is evident in the use of this database to answer a wide variety of healthcare-related questions across a number of medical specialties. 8–10 …”

Comparison of injectable anticoagulants for thromboprophylaxis after cancer-related surgery

“…The data set was developed for measuring the quality and use of health care and has been used in previous economic and clinical assessments. [18][19][20][21][22][23] As the largest database in the United States for hospital-quality benchmarking, it contains linked, deidentified, inpatient medical, pharmacy, and billing data from more than 600 geographically dispersed hospitals. Participating hospitals are nationally representative based on number of beds, geographic location, and teaching hospital status.…”

Blood utilization: fostering an effective hospital transfusion culture

“…These inconsistencies also exist at regional levels and even within the same hospital. Blanchette et al assessed utilization and costs of blood management services for knee and hip surgeries in the U.S., concluding that most transfusion reduction techniques are underused or do not reduce transfusion [20]. Utilization rates included antifibrinolytics (0.14%), topical sealants (3.24%), volume expanders (3.89%), erythropoietic agents (5.08%), and hypotensive anesthesia (22.28%).…”