The Economic Burden of Bleeds and Transfusions in Selected Surgeries: A Retrospective Multi Center Analysis from the US Perspective| Biomed Grid

Objective: To identify the economic impact of bleeds and transfusions by analyzing the effect of hemostatic agents (active and passive) on adults undergoing Cardio Vascular/Thoracic & Ortho-Ortho Spine surgeries in US hospitals. Methods: A Retrospective review of intraoperative data from 72 Cardio Vascular/Thoracic, and 39 Ortho-Ortho Spine surgeries performed between August–December 2018, from different US Urban Hospitals was performed to determine the economic impact of bleeding and transfusions associated with the utilization efficiency of active or passive hemostatic agents. Results: Of the 111 cases analyzed, 157 hemostatic agents were used. Utilization efficiency (a percentage defined as the amount of product used divided by the amount opened) was calculated. Utilization efficiency or products such as Flowable were 84% and Sealants 97%, Products with medium utilization efficiency such as Gelatin Powder were 76% and Oxidized Cellulose 72%, and products with a low utilization efficiency such as Thrombin were 46%, and Gelatin Sponge & Bone Wax 42%. The average estimated blood loss for all surgeries was 455 mL. The total blood product units used included Packed Red Blood Cells (PRBC) 12U, Fresh Frozen Plasma (FFP) and Platelets 10U, and Cryoprecipitate 52U. The economic impact of bleeding and transfusions ranged from $9,824 to $29,296 depending on the surgery and the hemostatic agent used. Conclusions: Surgical bleeds and transfusions can have substantial financial and medical consequences. Using appropriate hemostatic agents intraoperatively may potentially reduce bleeds requiring transfusion and likely improve patient post-surgical outcomes. The use of active hemostatic agents resulted in a substantial Blood Product Use savings of $19,472 (50%) per patient. The use of active hemostatic agents may result in effective and cost-beneficial outcomes compared with passive hemostatic agents