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4937
Postoperative complications, hospital length of stay, and cost in sickle cell patients undergoing cholecystectomy, appendectomy, and hysterectomy
Session: MP-01a
Thurs, April 19, 8-9:45 am
Shubert (Shubert Complex), 6th floor

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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

 

Introduction

 

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.

 

 

Methods

 

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.

Results

 

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).

 

Conclusions

•SCD patients undergoing abdominal surgery have complicated and prolonged hospital courses. This knowledge can be used to inform clinical and administrative decisions.

References

1.Dinan MA et al. Outcomes of inpatients with and without sickle cell disease after high-volume surgical procedures. Am J Hematol. 2009; 84(11): 703-709.
2.Kauf TL, Coates TD, Huazhi L, Mody-Patel N, Hartzema AG. The cost of health care for children and adults with sickle cell disease. Am J Hematol. 2009;84(6):323–327.
3.Enayatollahi MA, Novack TA, Maltenfort MG, Tabatabaee RM, Chen AF, Parvizi J. In-Hospital Morbidity and Mortality Following Total Joint Arthroplasty in Patients with Hemoglobinopathies.  J Arthroplasty. 2015 Aug;30(8):1308-12.
4.Perfetti DC, Boylan MR, Naziri Q, Khanuja HS, Urban WP. Does sickle cell disease increase risk of adverse outcomes following total hip and knee arthroplasty? A nationwide database study. J Arthroplasty. 2015 Apr;30(4):547-51.
5.Kamble S, Telen M, Dinan M, et al. Costs and length of stay for patients with and without sickle cell disease after hysterectomy, appendectomy, or knee replacement. Am J Hematol. 2010; 85(1):79-81.

 

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