The clinical and economic burden of significant bleeding during lung resection surgery: A retrospective matched cohort analysis of real-world data.
OBJECTIVE
The objective of this retrospective study was to quantify the clinical and economic burden of significant bleeding in lung resection surgery in the US.


METHODS
This study utilized 2009-2012 data from the Premier Perspective DatabaseTM. Adult patients with primary pulmonary lobectomy or segmentectomy procedures were categorized by the surgical approach (VATS vs open) and primary diagnosis (primary or metastatic lung cancer vs non-lung cancer). Patients requiring ≥3 units of blood products with at least 1 unit of PRBCs: "significant bleeding" cohort; those requiring <3 units: "non-significant bleeding" cohort; and those not requiring blood products: "no bleeding" cohort. A matched cohort analysis was performed between the "significant bleeding" and the "no bleeding cohort" using matching variables: hospital, lung cancer diagnosis, year of surgery, APR-DRG severity score, procedure type and approach, age, and gender.


RESULTS
The "All-patient" cohort comprised 21,429 patients: 213 "significant bleeding"; 2,780 "non-significant bleeding"; and 18,436 "no bleeding". Overall incidence of significant chest bleeding was 0.99%. Patients from "significant bleeding" cohort and "non-significant bleeding" cohort had 2.5 days and 2 days (p < 0.0001) longer length of stay in the hospital compared to those in the "no bleeding" cohort, respectively. Overall, hospital costs for "significant bleeding" cohort were higher than "no bleeding" cohort for those who were covered under Medicare ($59,871 vs $23,641), were ≥76 years of age ($64,010 vs $24,243), had greater severity of illness ($97,813 vs $51,871) and underwent open segmentectomy ($74,220 vs $21,903). Hospital costs for "significant bleeding" cohort and "non-significant bleeding" were significantly higher ($11,589 and $5,280, respectively, p < 0.0001) than no bleeding cohort.


CONCLUSIONS
Although significant bleeding during lung resection surgery is rare, patients with such complication could stay longer at the hospital and cost an average of $13,103 more than those without.
a Global Health Economics and Market Access, Johnson & Johnson (Ethicon) , Cincinnati , OH , USA.
Sudip K
SK
Ghosh
a Global Health Economics and Market Access, Johnson & Johnson (Ethicon) , Cincinnati , OH , USA.
Sanjoy
S
Roy
b Global Epidemiology & Health Informatics, Johnson & Johnson Medical Devices , New Brunswick , NJ , USA.
Mehmet
M
Daskiran
b Global Epidemiology & Health Informatics, Johnson & Johnson Medical Devices , New Brunswick , NJ , USA.
Andrew
A
Yoo
b Global Epidemiology & Health Informatics, Johnson & Johnson Medical Devices , New Brunswick , NJ , USA.
Gang
G
Li
c Global Medical Affairs, Johnson & Johnson Medical Devices , Cincinnati , OH , USA.
Elliott J
EJ
Fegelman
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D017281:Cost of Illness; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000191:economics*; D012189:Retrospective Studies; D013903:Thoracic Surgery / Q000191:economics* / Q000379:methods
Bleeding; Complication; Cost; Thoracic surgery; VATS