Postoperative acquired coagulopathy: a pilot study to determine the impact on clinical and economic outcomes.
OBJECTIVE
To characterize the clinical factors associated with postoperative acquired coagulopathy, and to estimate the economic impact of resources used to treat postoperative patients with this coagulopathy compared with postoperative patients who did not develop the coagulopathy.


METHODS
Case-control study.


METHODS
Academically affiliated public hospital and level I trauma referral center.


METHODS
Twenty-six patients (mean age 53.9 yrs) who experienced acquired coagulopathy after undergoing an index surgery (cases), and 26 patients (mean age 50.8 yrs) matched to these case patients by index surgery, age, and sex (controls).


RESULTS
Data were collected from a database of 5367 adult surgical admissions over 6 months during 2008, corresponding inpatient electronic health records, billing data, and Medicare Resource-Based Relative Value Scale payments. Case patients had a minimum of two postoperative consecutively drawn episodes of prothrombin time (PT) or activated partial thromboplastin time (aPTT) elevated to greater than 20% above the upper limit of normal. Patients with inherited clotting disorders or other identifiable causes of coagulopathy were excluded. Case patients underwent the following surgeries: 12 orthopedic (46%), six cardiovascular (23%), four gastrointestinal (15%), and four neurosurgical (15%). Mean values of the first elevated PT and aPTT were 19.7 and 50.8 seconds, respectively. Mean postoperative stay was 31.5 days for cases versus 9.8 days for controls (p<0.05). Mean cost (2008 U.S. dollars) of resources used was $112,280 for cases versus $38,357 for controls (p<0.001). Costs incurred between the onset of coagulopathy and discharge constituted 67% of postoperative costs. Physician reimbursement expenditures were minimal.


CONCLUSIONS
Postoperative acquired coagulopathy was associated with stays that were 3 times longer and resource use costs that were 3 times higher than those of controls. This type of coagulopathy may be an under-recognized and underappreciated event. The case-control design is limited to exploring associations and does not establish causality. Prospective studies need to be conducted to establish the causes of acquired coagulopathy and methods for screening and diagnosing this condition.
Devine
Emily Beth
EB
Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington 98195-7630, USA. bdevine@uw.edu
Chan
Lingtak-Neander
LN
Babigumira
Joseph
J
Kao
Henry
H
Drysdale
Troy
T
Reilly
Dominic
D
Sullivan
Sean
S
D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000191:economics*; D016022:Case-Control Studies; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D005791:Patient Care / Q000191:economics; D010865:Pilot Projects; D011184:Postoperative Period; D011517:Prothrombin Time; D016896:Treatment Outcome