Anemia, Colon Cancer, Economic Problems, Surgery, Surgical Blood Loss
Conditions
Brief summary
The objective is to measure the adjusted association between preoperative anemia and total hospital costs. We hypothesize that patients with anemia before surgery will have higher hospitalization costs than people without anemia.
Detailed description
This study will examine the association between preoperative anemia (hematocrit less than 0.39; low blood counts) and hospital total costs from elective colorectal surgery. Total costs will be defined as the combination of direct and indirect costs ascertained using standardized patient-level costing algorithms (i.e. the standard way that hospital measure their costs). Adjustment will be made for factors that are likely to influence both the presence of anemia and costs of care.
Interventions
OTHERAnemia
Hematocrit less than 0.39
Sponsors
Ottawa Hospital Research Institute
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Elective hospital admission * having colorectal surgery
Exclusion criteria
* not enrolled in national surgical quality improvement program data collection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total Hospital Costs | Hospital admission to date of discharge from hospital, or 365 days after admission, whichever came first | Direct and indirect costs accrued during the index hospitalization. Costs were measured using standard and validated algorithms, standardized to 2016 CAD. This method accounts for a patient's resource intensity weight, their case mix group, as well as fixed patient costs (e.g., medications, investigations) and indirect costs to the hospital based on patient's location of care (intensive care unit versus ward) and length of stay. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of Stay | Date of surgery to date of hospital discharge, or up to one year after surgery (whichever comes first) | Number of days in hospital after surgery |
| Red Blood Cell Transfusion | Hospital admission to date of surgery, or 365 days after admission, whichever came first | Any red blood cell transfusion received |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Anemic People with a preoperative hematocrit less than 0.39
Anemia: Hematocrit less than 0.39 | 381 |
| Non-anemic People with a preoperative hematocrit greater than or equal to 0.39 | 470 |
| Total | 851 |
Baseline characteristics
| Characteristic | Anemic | Non-anemic | Total |
|---|---|---|---|
| Age, Customized Age < 65 | 123 Participants | 272 Participants | 395 Participants |
| Age, Customized Age 65-74 | 105 Participants | 117 Participants | 222 Participants |
| Age, Customized Age 75-84 | 114 Participants | 67 Participants | 181 Participants |
| Age, Customized Age >84 | 39 Participants | 14 Participants | 53 Participants |
| American Society of Anesthesiology (ASA) Score III | 260 Participants | 302 Participants | 562 Participants |
| American Society of Anesthesiology (ASA) Score I-II | 51 Participants | 142 Participants | 193 Participants |
| American Society of Anesthesiology (ASA) Score IV-V | 70 Participants | 26 Participants | 96 Participants |
| Elixhauser comorbidity index | 6.16 Index STANDARD_DEVIATION 5.98 | 5.50 Index STANDARD_DEVIATION 5.89 | 6 Index STANDARD_DEVIATION 6 |
| Independent Functional Status | 353 Participants | 467 Participants | 820 Participants |
| Procedural Index for Mortality Risk (PIMR) Score | 0.47 Number of procedural risk points STANDARD_DEVIATION 1.39 | 0.17 Number of procedural risk points STANDARD_DEVIATION 0.7 | 0.3 Number of procedural risk points STANDARD_DEVIATION 1.1 |
| Sex: Female, Male Female | 214 Participants | 181 Participants | 395 Participants |
| Sex: Female, Male Male | 167 Participants | 289 Participants | 456 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Total Hospital Costs
Direct and indirect costs accrued during the index hospitalization. Costs were measured using standard and validated algorithms, standardized to 2016 CAD. This method accounts for a patient's resource intensity weight, their case mix group, as well as fixed patient costs (e.g., medications, investigations) and indirect costs to the hospital based on patient's location of care (intensive care unit versus ward) and length of stay.
Time frame: Hospital admission to date of discharge from hospital, or 365 days after admission, whichever came first
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Anemic | Total Hospital Costs | 23,667 Dollars |
| Non-anemic | Total Hospital Costs | 17,100 Dollars |
Secondary
Length of Stay
Number of days in hospital after surgery
Time frame: Date of surgery to date of hospital discharge, or up to one year after surgery (whichever comes first)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Anemic | Length of Stay | 12.4 Days | Standard Deviation 17.5 |
| Non-anemic | Length of Stay | 8.5 Days | Standard Deviation 7.5 |
Secondary
Red Blood Cell Transfusion
Any red blood cell transfusion received
Time frame: Hospital admission to date of surgery, or 365 days after admission, whichever came first
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Anemic | Red Blood Cell Transfusion | 88 Participants |
| Non-anemic | Red Blood Cell Transfusion | 18 Participants |