Outcomes of inpatients with and without sickle cell disease after high-volume surgical procedures.
In this study, we examined differences in inpatient costs, length of stay, and in-hospital mortality between hospitalizations for patients with and without sickle cell disease (SCD) undergoing high-volume surgical procedures. We used Clinical Classification Software (CCS) codes to identify discharges in the 2002-2005 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for patients who had undergone either cholecystectomy or hip replacement. We limited the non-SCD cohort to hospitals where patients with SCD had undergone the same procedure. We compared inpatient outcomes using summary statistics and generalized linear regression analysis to adjust for patient, hospital, and procedural characteristics. Overall, the median age of surgical patients with SCD was more than three decades less than the median age of patients without SCD undergoing the same procedure. In recognition of the age disparity, we limited the analyses to patients aged 18 to 64 years. Nonetheless, patients with SCD undergoing cholecystectomy or hip replacement were 12.1 and 14.4 years younger, had inpatient stays that were 73% and 82% longer, and incurred costs that were 46% and 40% higher per discharge than patients without SCD, respectively. Inpatient mortality for these procedures was low, approximately 0.6% for cholecystectomy and 0.2% for hip replacement and did not differ significantly between patients with and without SCD. Multivariable regression analyses revealed that higher inpatient costs among patients with SCD were primarily attributable to longer hospital stays. Patients with SCD who underwent cholecystectomy or hip replacement required more health care resources than patients without SCD. Am. J. Hematol. 2009. (c) 2009 Wiley-Liss, Inc.
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Michaela A
MA
Dinan
Chia-Hung
CH
Chou
Bradley G
BG
Hammill
Felicia L
FL
Graham
Kevin A
KA
Schulman
Marilyn J
MJ
Telen
Shelby D
SD
Reed
D000328:Adult; D000755:Anemia, Sickle Cell / Q000191:economics / Q000401:mortality; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000191:economics / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult