Clinical and economic consequences of bleeding following major orthopedic surgery.

BACKGROUND: Major orthopedic surgery patients who receive antithrombotics as prophylaxis against VTE may be at higher risk of bleeding. The clinical and economic consequences of this complication may be relevant to therapeutic decision-making.
OBJECTIVE: To assess the impact of major bleeding following major orthopedic surgery on length of stay (LOS) and inpatient charges.
METHODS: Using a database with information on approximately 750,000 admissions annually to 100+ US acute-care hospitals, we identified all patients who underwent major orthopedic surgery between January 1, 1998 and December 13, 2000. Patients were stratified 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)>or=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: The incidence of major bleeding among 23,518 patients who underwent major orthopedic surgery 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 among those with major bleeding (95% CI: 1.5, 2.0) (6.1 days vs. 4.3 days for those without bleeds); adjusted mean total inpatient charges were 7,593 dollars higher (95% CI: 6,622 dollars, 8,646 dollars) (25,669 dollars vs. 18,076 dollars).
CONCLUSION: Bleeding following major orthopedic surgery may increase length of stay and total hospital charges and should be an important consideration in choice of VTE prophylaxis.