Sorathia Tanay, Lee Jennifer J, Faraoni David, Lenke Lawrence G, Li Guohua, Eisler Lisa
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Spine J. 2025 Apr 22. doi: 10.1016/j.spinee.2025.04.023.
Preoperative anemia is associated with the need for red blood cell (RBC) transfusion and extended hospital stays in pediatric patients undergoing spinal deformity surgery.
This study sought to identify excess hospital costs associated with preoperative anemia in this population.
Retrospective review of linked procedure records from prospectively maintained institutional databases.
Patients aged 2 to 18 years old who underwent posterior spinal fusion surgery at our institution from 2017 to 2023 were identified through procedure-related data collected as part of the National Surgical Quality Improvement Program and Pediatric Health Information Systems databases.
The primary outcome measure was total hospital costs, as derived from billed services and the hospital's department level costs-to-charge ratios, with RBC transfusion as a mediating outcome.
Linear regression estimated the association between preoperative anemia and increased hospital costs, adjusting for age, sex, American Society of Anesthesiologists physical status classification, number of spinal levels fused, and surgical duration. The unified framework for mediation and interaction identified whether RBC transfusion was a significant mediator of this association.
Of 672 patients, 10.6% (n=71) were anemic on preoperative testing. Higher median total hospital costs were seen for those with preoperative anemia than those without ($49,370 vs. $41,044; p<.001). Linear regression on log-transformed cost data indicated that those with anemia had 18.0% (95% CI: 4.5%-33.2%; p=.008) higher total hospital costs after adjustment for covariates, highlighting 95% confidence in a cost excess of at least $2,448 in anemic patients. RBC transfusion was more common in anemic patients (63.4% vs. 46.8%, p=.008) and significantly mediated the observed association with costs.
Preoperative anemia is independently associated with increased healthcare costs during the surgical treatment of spinal deformity in children, with anemic patients incurring thousands of dollars of additional costs driven in part by those associated with RBC transfusion. Depending on the expense and efficacy of hemoglobin optimization strategies, these findings highlight the potential for a cost-effective intervention to treat preoperative anemia in vulnerable populations.
术前贫血与接受脊柱畸形手术的儿科患者需要输注红细胞以及住院时间延长有关。
本研究旨在确定该人群中与术前贫血相关的额外住院费用。
对前瞻性维护的机构数据库中的关联手术记录进行回顾性分析。
通过作为国家外科质量改进计划和儿科健康信息系统数据库一部分收集的手术相关数据，确定了2017年至2023年在本机构接受后路脊柱融合手术的2至18岁患者。
主要结局指标是总住院费用，从计费服务和医院科室层面的成本收费比率得出，输注红细胞作为中介结局。
线性回归估计术前贫血与住院费用增加之间的关联，并对年龄、性别、美国麻醉医师协会身体状况分类、融合的脊柱节段数和手术持续时间进行调整。中介和交互作用的统一框架确定了输注红细胞是否是这种关联的重要中介因素。
在672例患者中，10.6%（n = 71）术前检查贫血。术前贫血患者的总住院费用中位数高于非贫血患者（49,370美元对41,044美元；p <.001）。对对数转换后的成本数据进行线性回归表明，调整协变量后，贫血患者的总住院费用高出18.0%（95%CI：4.5% - 33.2%；p =.008），这表明对贫血患者至少高出2,448美元的成本超支有95%的置信度。输注红细胞在贫血患者中更常见（63.4%对46.8%，p =.008），并显著介导了观察到的与费用的关联。
术前贫血与儿童脊柱畸形手术治疗期间医疗费用增加独立相关，贫血患者产生数千美元的额外费用，部分原因是与输注红细胞相关的费用。根据血红蛋白优化策略的费用和效果，这些发现凸显了在弱势群体中进行具有成本效益的干预以治疗术前贫血的潜力。
