Postoperative Complications, hospital length of stay, and cost in sickle cell patients undergoing cholecystectomy, appendectomy, and hysterectomy
2018 World Congress on Regional Anesthesia & Pain Medicine
John Brumm, MD, Robert S. White, MD, Harmandeep Singh, MD, Noelle S. Arroyo, BA, Licia K. Gaber-Baylis, BA, Zachary A. Turnbull, MD, and Neel Mehta, MD
April 19, 2018
Sickle cell disease (SCD) is the most common inherited hemoglobinopathy in the United States affecting over 70,000 Americans costing the US healthcare system $1.6 billion per year.
Previous limited research has shown that SCD is associated with increased postoperative complications, prolonged hospital stays, and higher hospital cost.
The purpose of our study was to update and expand the literature, on postoperative complications, length of stay, and hospital charges in SCD patients after three common abdominal surgeries: cholecystectomy, appendectomy, and hysterectomy.
We conducted a retrospective analysis of patients, aged >18, undergoing inpatient cholecystectomy, appendectomy, and hysterectomy using the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Health Research and Quality from 2007-2014.
The primary outcomes of our study were hospital length of stay and total hospital charges, compared separately between SCD and non-SCD patients as indicated by the unadjusted rate and adjusted odds ratio (OR). Secondary outcomes were rates and odds of blood transfusion, major complications, and minor complications.
Compared to the overall study population, SCD patients were younger, more likely to be black, have Medicaid, live in the lowest median household quartile, have an emergency procedure performed, and have co-morbidities present on admission
SCD patients incurred a 1700% increase in the odds of blood transfusion, 118% increase in the odds of a minor complication, and a 234% increase in the odds of a major complication.
SCD was associated with increased length of stay (OR 1.67, 95% CI 1.60-1.74) and log transformed total hospital charges (OR 1.36, 95% CI 1.32-1.41).