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J Thorac Cardiovasc Surg 2009;138:687-693
© 2009 The American Association for Thoracic Surgery

Perioperative Management

Costs of excessive postoperative hemorrhage in cardiac surgery

^a Global Development, Novo Nordisk A/S, Bagsværd, Denmark
^b Klinik für Herzchirurgie, Herzzentrum Augsburg, Augsburg, Germany
^c Pharmametrics GmbH, Institute for Health Economics & Epidemiology, Freiburg, Germany
^d Department of Anaesthesiology and Intensive Care Medicine, Charité-University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany

Received for publication March 17, 2008; revisions received September 12, 2008; accepted for publication February 2, 2009.

^_* Address for reprints: Michael C. Christensen, MSc, MPA, DrPH, Global Development, Novo Nordisk A/S, Krogshoejvej 55, 2880 Bagsvaerd, Denmark. (Email: mcrc{at}novonordisk.com).

Background: Excessive postoperative hemorrhage in cardiac surgery is a serious clinical complication placing substantial demands on hospital resources. This study quantifies the exact impact of postoperative hemorrhage on hospital costs in Germany.

Methods: We retrospectively analyzed data collected prospectively in the Quality Assurance Database at the Heart Center of the Klinikum Augsburg, Germany. All relevant perioperative data for resources consumption were analyzed and compared in patients with and without excessive postoperative hemorrhage in cardiac surgery. Multivariate regression analysis identified the incremental costs of postoperative hemorrhage while adjusting for potential confounding.

Results: A total of 1118 patients had cardiac surgery between January and December 2006. Six percent were identified with excessive postoperative hemorrhage. The risk of experiencing a postoperative complication (including death) (P < .0001), returning to operating room for reexploration (P < .0001), staying in intensive care unit for longer than 72 hours (P < .0001), receiving ventilation for longer than 24 hours (P < .0001), and receiving any kind of postoperative blood transfusion (P < .0001) was significantly higher in patients with excessive postoperative hemorrhage. Twenty-two percent of patients with excessive postoperative hemorrhage died compared with 6% of the patients without excessive postoperative hemorrhage (P < .0001). When adjusting for potential confounding factors, the incremental costs of excessive postoperative hemorrhage was \#8364;6251 (95% confidence interval, 4594–7909).

Conclusions: The average hospital costs related to excessive postoperative hemorrhage in cardiac surgery in Germany are substantial and associated with a significant risk of postoperative complications and death. Clinical interventions that can effectively prevent or address excessive postoperative hemorrhage in cardiac surgery are likely to have substantial cost-effectiveness potential.