title: Restrictive versus liberal red blood cell transfusion strategy after hip surgery: a decision model analysis of healthcare costs.
abstract: Red blood cell transfusion related to select surgical procedures accounts for approximately 2.8 million transfusions in the United States yearly and occurs commonly after hip fracture surgeries. Randomized controlled trials have demonstrated lack of clinical benefit with higher versus lower transfusion thresholds in postoperative hip fracture repair patients with cardiac disease or risk factors for cardiac disease. The economic implications of a higher versus lower hemoglobin (Hb) threshold have not yet been investigated.
  
  
  
  A decision tree analysis was constructed to estimate differences in healthcare costs and charges between a Hb transfusion threshold strategy of 8 g/dL versus 10 g/dL from the perspective of both Centers for Medicare and Medicaid Services (CMS) as well as hospitals. Secondary outcome measures included differences in transfusion-related adverse events.
  
  
  
  Among the 133,697 Medicare beneficiaries undergoing hip fracture repair in 2012, we estimated that 45,457 patients would be anemic and at risk for transfusion. CMS would save an estimated $11.3 million to $24.3 million in payments, while hospitals would reduce charges by an estimated $52.7 million to $93.6 million if the restrictive transfusion strategy were to be implemented nationally. Additionally, rates of transfusion-associated circulatory overload, transfusion-related acute lung injury, acute transfusion reactions, length of stay, and mortality would be reduced.
  
  
  
  This model suggests that the uniform adoption of a restrictive transfusion strategy among patients with cardiac disease and risk factors for cardiac disease undergoing hip fracture repair would result in significant reductions in clinically important outcomes with significant cost savings.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Mario V
authors.initials: MV
authors.lastname: Fusaro
authors.affiliation: Section of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Nielsen
authors.affiliation: Department of Systems Science, Portland State University, Portland, Oregon.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nielsen
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Magali J
authors.initials: MJ
authors.lastname: Fontaine
authors.affiliation: Division of Laboratory Medicine and Hematology, University of Washington Harborview Medical Center, Seattle, Washington.
authors.forename: John R
authors.identifier: 0000-0001-8596-4420
authors.initials: JR
authors.lastname: Hess
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Reed
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Tulane University School of Medicine, New Orleans, Louisiana.
authors.forename: Sylvain
authors.initials: S
authors.lastname: DeLisle
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Tulane University School of Medicine, New Orleans, Louisiana.|Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
mesh_terms: D003365:Costs and Cost Analysis; D003657:Decision Making; D017707:Erythrocyte Transfusion / Q000191:economics*; D005260:Female; D006331:Heart Diseases / Q000191:economics / Q000628:therapy; D006620:Hip Fractures / Q000191:economics* / Q000601:surgery*; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D018803:Models, Economic; D012307:Risk Factors; D014481:United States