Impact of an active hemostatic product treatment approach on bleeding-related complications and hospital costs among inpatient surgeries in the United States.

AIMS

To examine the impact of active only (A) vs. combined passive and active (PA) hemostatic products on bleeding-related complications and costs among inpatient surgeries.

MATERIALS AND METHODS

This retrospective analysis of the US Premier Hospital Database included patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, noncardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, spinal, or neurosurgery) that utilized a hemostatic product from January 1, 2017 to December 31, 2018. Patients were directly matched 1:1 on surgery code, age categories, and Charlson Comorbidity Index score categories into A or PA cohorts. Unadjusted and adjusted rates of bleeding-related complications, length of stay (LOS) and total hospital costs were compared between cohorts.

RESULTS

A total of 5,934 cardiac, 7,986 vascular, 2,042 noncardiac thoracic, 8,260 solid organ, 9,502 general, 4,616 reproductive organ, 2,758 knee/hip replacement, 42,648 spinal, and 10,716 neuro surgeries were included. Higher unadjusted rates of bleeding-related complications and greater LOS and total hospital costs were observed in the PA cohort vs A cohort across all specialties. The adjusted odds of bleeding complications were significantly higher in solid organ, general, knee/hip replacement, reproductive organ, and spinal surgery (OR range = 1.17-2.48, all  <.01), while incremental costs per hospitalization associated with PA (vs A) controlling for covariates were higher across all specialties (ratio range = 1.04-1.22, all  <.05).

LIMITATIONS

This analysis focused on patients who had a single surgery during the hospital encounter; results may not be generalizable to patients undergoing multiple surgeries.

CONCLUSIONS

The use of A hemostatic products was associated with significantly lower rates of bleeding-related complications and total hospital costs compared to PA hemostatic products. A treatment approach which considers bleeding-related factors including severity, risk and variability based on surgery type may provide guidance in choosing the optimal hemostatic product to improve surgical outcomes and costs.