Retrospective Database Analysis of the Clinical and Economic Outcomes Associated with Disruptive Surgical Bleeding

Mosadoluwa Afolabi,1 Prathiksha N V,2 Amitha Kumar,3 Walter A Danker III,3 Stephen S Johnston1 1Global Epidemiology, Johnson & Johnson MedTech, New Brunswick, NJ, USA; 2Decision Sciences, Mu Sigma, Bangalore, India; 3Health Economics and Market Access, Johnson & Johnson Medtech, Raritan, NJ, USACorrespondence: Stephen S Johnston, Global Epidemiology, Johnson & Johnson MedTech, 410 George Street, New Brunswick, NJ, 08901, USA, Tel +1-443-254-2222, Email [email protected]: This study evaluated the clinical and economic outcomes associated with disruptive surgical bleeding (ie, hemorrhage/hematoma that complicates a procedure despite the use of hemostatic agents) among patients with bariatric, colorectal, spine, total hip arthroplasty (THA), and total knee arthroplasty (TKA) surgery.Methods: Premier Healthcare Database patients aged ≥ 18 with one of the five procedures and hemostatic agent use between January 1-December 31, 2019, were included. Clinical and economic outcomes (ie, operating room time, 90-day all-cause inpatient readmission, in-hospital mortality, intensive care unit [ICU] admission/duration, ventilator use, hospital costs, and length of stay [LOS]) were compared between patients with and without disruptive surgical bleeding. Multivariable analyses adjusted for differences in baseline characteristics.Results: Among 119,994 patients meeting inclusion criteria, 10.8% had disruptive surgical bleeding despite the use of hemostatic agents (bariatric surgery 5.4%, colorectal surgery 20.0%, spine surgery 11.0%, THA 11.5%, TKA 5.6%). Disruptive bleeding was associated with significantly longer operating room times for bariatric, colorectal, and spine surgery (incremental increases 42.3– 62.4 minutes; p≤ 0.001), increased 90-day all-cause readmission risks for bariatric and spine surgery (incremental absolute risk increases 4.1% bariatric, 0.7% spine; both p=0.011), and increased inpatient mortality risk for all procedures except TKA (incremental absolute risk increases 0.2– 55.0%; p≤ 0.001). ICU admission risks were increased for all procedures except TKA (incremental absolute risk increases 3.0– 21.4%; p≤ 0.05), and ICU days were increased for bariatric, colorectal, and spine surgery (incremental increases 0.8– 2.8 days; p≤ 0.001). Risks for ventilator use were higher for all procedures except THA (incremental absolute risk increases 3.5– 25.2%; p≤ 0.05). Disruptive bleeding increased hospital costs (incremental increases $3,377–$23,346; p≤ 0.05) and LOS (incremental increases 1.0– 4.9 days; p≤ 0.05) for all five procedures.Conclusion: The clinical and economic burden of disruptive bleeding despite hemostatic agent use among patients with bariatric, colorectal, spine, THA, and TKA surgery was substantial, highlighting the need for improved surgical bleeding interventions.Keywords: surgical bleeding, hemostatic agent, health resource utilization, hospital costs, real-world evidence