Restrictive Versus Liberal Red Blood Cell Transfusion Strategy After Hip Surgery: A Decision Model Analysis of Healthcare Costs

Authors

Mario V. Fusaro, Tulane University
Nathan D. Nielsen, Tulane UniversityFollow
Alexandra Nielsen, Portland State UniversityFollow
Magali J. Fontaine, University of Maryland
John R. Hess, University of Washington
Robert M. Reed, Tulane University
Sylvain DeLisle, Tulane University
Giora Netzer, Tulane University

Published In

Transfusion

Document Type

Citation

Publication Date

2-2017

Abstract

BACKGROUND: 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.

STUDY DESIGN AND METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Description

© 2016 AABB

Locate the Document

https://doi.org/10.1111/trf.13936

DOI

10.1111/trf.13936

Persistent Identifier

http://archives.pdx.edu/ds/psu/20415

Citation Details

Fusaro, M. V., Nielsen, N. D., Nielsen, A., Fontaine, M. J., Hess, J. R., Reed, R. M., & ... Netzer, G. (2017). Restrictive versus liberal red blood cell transfusion strategy after hip surgery: a decision model analysis of healthcare costs. Transfusion, 57(2), 357-366.