Cost of Major Bleeding Following Major Orthopedic Surgery.

Rationale. The risk of major bleeding in major orthopedic surgery (MOS) patients who receive antithrombotics as prophylaxis against venous thromboembolism (VTE) may be higher for some agents than others. The cost of this complication is unknown.

Objective. To assess the impact of major bleeding following MOS on length of stay (LOS) and inpatient charges.

Methods. Using a database with information on ~750,000 admissions annually to 100+ US acute-care hospitals (MQProfile, Cardinal Information Corp.), we identified all patients who underwent MOS between 1/1/98 and 12/13/00. We stratified patients according to whether or not they experienced major postoperative bleeding prior to hospital discharge, defined as: (a) fatal bleeding; (b) nonfatal bleeding at critical site; (c) re-operation due to bleeding; and (d) overt bleeding with bleeding index (BI) ≥ 2, where BI = number of blood units transfused plus pre-bleeding minus post-bleeding hemoglobin (g/dL) values. LOS and total inpatient charges were compared between patients with and without major bleeding.

Results. 23,518 patients were identified who underwent MOS. Incidence of major bleeding was 2.6%. In multivariate analyses controlling for differences in baseline characteristics between patients with and without major bleeds, adjusted mean LOS was 1.8 days longer (95% CI: 1.5, 2.0) among the former (6.1 days vs 4.3 days for those without bleeds); adjusted mean total inpatient charges were $7,593 higher (95% CI: $6,622, $8,646) ($25,669 vs $18,076).

Conclusion. Major bleeding following MOS significantly increases LOS and hospital charges. The cost of major bleeding following MOS should factor into choice of VTE prophylaxis.