8556 Exploring the Impact of Preoperative Anemia on Postoperative Costs and Complications

Abstract

<h3>Study Objective</h3> To determine the difference in hospital costs associated in anemic versus non-anemic patients undergoing benign, elective hysterectomy. <h3>Design</h3> We included patients undergoing elective, benign hysterectomy between July 2016 and December 2020. Preoperative anemia was defined as a hemoglobin <120 g/L. Primary outcome was total estimated hospital cost, in Canadian dollars (CAD), including index admission and complications requiring emergency room visit and/or readmission. Costs for outpatient physician services or indirect costs associated with quality of life and loss in productivity were not accounted for. Multivariable regression analysis adjusting for patient and surgical covariates was used to measure association between anemia and cost. <h3>Setting</h3> Nine Canadian hospitals (6 academic, 3 community). <h3>Patients or Participants</h3> Our data captured 4557 patients undergoing benign, elective hysterectomy. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Of the 4557 patients who underwent elective hysterectomy, 909 (19.9%) had preoperative anemia. After adjusting for differences in covariates between groups, mean hospital cost per hysterectomy was significantly higher in anemic compared to non-anemic patients ($7465.36 ± $2022.86 CAD vs $7082.56 CAD ± $941.16 CAD, p<0.001), translating into a 5.4% increase. Primary drivers of increased cost in the anemic group were increased length of stay (30 vs 29 days, p=0.005), perioperative blood transfusions (7.7% vs 1.3%, p<0.001) and iron infusions (2% vs 0.4%, p<0.001). <h3>Conclusion</h3> Preoperative anemia in patients undergoing elective hysterectomy for benign indications is associated with a significant increase in healthcare costs.