title: Cost of Bleeding in Trauma and Complex Cardiac Surgery.
abstract: OBJECTIVE
  Trauma and complex cardiac surgery are associated with a high risk of bleeding complications. The difference in costs between patients who require bleeding control measures and those who do not is poorly understood. Our goal was to assess the cost of care and outcomes for patients in these settings.
  
  
  METHODS
  Patients >18 years of age, who were discharged between January 2010 and December 2012, were retrospectively identified in the Premier Hospital Database based on International Classification of Disease, Ninth Revision codes. These patients were categorized as having received blood products ("bleeding patients") or not ("nonbleeding patients"). Patients with costs and length of stay (LOS) of zero were excluded. Differences in treatment costs and outcomes were assessed using univariate analysis and multivariate modeling.
  
  
  RESULTS
  Bleeding trauma patients (n = 8800) had a 150% higher total cost of care (P < 0.001; 146% after excluding costs of agents used for bleeding control, P < 0.001), an 81.3% longer hospital LOS (P < 0.001), and a 65.2% longer intensive care unit (ICU) LOS (P < 0.001) than nonbleeding patients (n = 53,727). Bleeding complex cardiac surgery patients (n = 82,832) had a 133.2% higher total cost of care (P < 0.001; 128.7% after excluding costs of agents used for bleeding control, P < 0.001), a 155.6% longer hospital LOS (P < 0.001), and an 89.3% longer ICU LOS (P < 0.001) than nonbleeding patients (n = 380,902).
  
  
  CONCLUSIONS
  Trauma and cardiac surgery patients who experienced bleeding and received allogeneic blood product transfusions had significantly worse outcomes, including longer LOS, greater inpatient mortality, and higher costs of care (even when excluding costs of agents used for bleeding control) than those who did not.
authors.affiliation: CSL Behring, King of Prussia, Pennsylvania. Electronic address: art.zbrozek@cslbehring.com.
authors.forename: Arthur
authors.initials: A
authors.lastname: Zbrozek
authors.affiliation: Premier Research Services, Charlotte, North Carolina.
authors.forename: Glenn
authors.initials: G
authors.lastname: Magee
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000191:economics; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006470:Hemorrhage / Q000191:economics* / Q000209:etiology / Q000628:therapy; D006488:Hemostasis, Surgical / Q000191:economics; D006489:Hemostatic Techniques / Q000191:economics*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000191:economics*; D055815:Young Adult
keywords: blood transfusion; cardiac surgery; patient outcomes; pharmacoeconomics; trauma