title: Burden of blood transfusion in knee and hip surgery in the US and Belgium.
abstract: OBJECTIVE
  Transfusion services in orthopaedic surgery can lead to unnecessary complications and increased healthcare costs. The objective of this study was to assess treatments and costs associated with blood and blood product transfusions in a historical cohort of 189,457 inpatients in the US and 34,987 inpatients in Belgium undergoing knee or hip surgery.
  
  
  METHODS
  Descriptive analysis, logistic regression and ordinary least squares regression were used to describe the factors associated with the use and cost of allogeneic blood transfusion.
  
  
  RESULTS
  Hospitalisation costs for joint replacement surgery totalled $12,718 (SD=6,356) and averaged 4.33 days in the US, while costs in Belgium were $6,526 (SD=3,192) and averaged 17.1 days. The use of low molecular weight heparin and tranexamic acid was much higher in Belgium than the US (36% and 99% compared to 0% and 40%, respectively). Patients in the US spent 12.7 (p<0.0001) fewer days in the hospital, 0.3 (p<0.0001) fewer days in the intensive care unit and were 88% less likely to have allogeneic blood transfusions (OR=0.22, 95% CI 0.22-0.23), but incurred $6,483 (p<0.0001) more costs per hospitalisation than patients in Belgium.
  
  
  CONCLUSIONS
  While hospital costs for patients were greater in the US, length of stay was shorter and patients were less likely to have transfusion services than those patients in Belgium. While this study is limited by factors inherent to observational studies, such as omitted variable bias, misclassification, and disease comorbidity, there are substantial differences in the use of blood products between Belgium and the US.
authors.affiliation: Lovelace Respiratory Research Institute, Albuquerque, NM, USA. cblanchette@LRRI.org
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Blanchette
authors.forename: Ashish V
authors.initials: AV
authors.lastname: Joshi
authors.forename: Marek
authors.initials: M
authors.lastname: Szpalski
authors.forename: Robert
authors.initials: R
authors.lastname: Gunzburg
authors.forename: Mark
authors.initials: M
authors.lastname: Du Bois
authors.forename: Peter
authors.initials: P
authors.lastname: Donceel
authors.forename: William B
authors.initials: WB
authors.lastname: Saunders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000191:economics*; D001530:Belgium; D001803:Blood Transfusion / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D003431:Cross-Cultural Comparison; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D065227:Transfusion Reaction; D014481:United States; D055815:Young Adult