PSY13 Systematic Review of the Economic and Epidemiological Burden of Bleeding-Related Complications in Hong Kong

Abstract

To explore peri-operative bleeding and its relationship with patient morbidity, mortality and increased health care costs in Hong Kong. EMBASE and Medline databases were searched to identify relevant epidemiological and economic studies. To ensure pertinence of the data, only studies published in the last 15 years were considered. Relevant studies were identified using a priori defined inclusion criteria relating to the patient population, setting and outcomes of interest. Eighteen studies were included in this systematic review. The mean volume of blood loss ranged from 20–2200 mL. Laparoscopic procedures were generally associated with lower blood loss (20–350 mL), while orthognathic and liver surgery were associated with greater blood loss (600–2200 mL). Similarly, the mean volume of blood transfused varied by surgical procedure ranging from 0.17 units (head and neck surgery) to 1.8 units (orthognathic surgery). With the cost of 1 unit of whole blood estimated at US$200 in Hong Kong, the need for transfusions potentially represent a substantial cost to patients and the health care system. The transfusion of blood during surgery was associated with increased risk of wound infection (OR 1.92–3.82, p≤0.02), post-operative complications (OR 2.63, p<0.001) and increased mortality (OR 1.6–10.2, p<0.05). Peri-operative blood transfusion was also associated with an increased hospital stay of 4.1 days in Hong Kong, equating to approximately US$4300 in excess hospital expenses. This review has identified several areas in which peri-operative bleeding may increase the burden to the Hong Kong health care system. This includes the greater need for transfusions, risk of complications and extended hospital stay. Accordingly, improvements in haemostasis have the potential to reduce direct health care resource utilisation through a reduction in blood use, hospital length of stay, need for additional procedures and patient mortality.