RecruitingACTRN12620000177954

The costs of anaemia after major surgery

The impact of preoperative anaemia on hospital costs following major abdominal surgery

Sponsor

Austin Health

Enrollment

1,300 participants

Start Date

Jan 30, 2020

Study Type

Observational

Conditions

Major abdominal surgery Anaemia

Summary

Preoperative anaemia is independently associated with an increased risk of postoperative morbidity and mortality and greater health care expenditure. The purpose of this study is to determine the costs associated with preoperative anaemia in patients undergoing major abdominal surgery. Who is it for? Eligible patients will include adult patients who underwent colonic, rectal, pancreatic or liver resections at the Austin Hospital between July 2010 and June 2018. All data will be retrospectively collected. Study details: Costs from the entire inpatients hospital admission will be collected from Austin Health's Business Unit. We will evaluate the association of preoperative haemoglobin levels and hospital costs. It is hoped that this study will: 1) Quantify the costs implicated by anaemia and the impact of anaemia on pharmacological costs, medical costs, operative costs, intensive care unit costs and ward costs. 2) Quantify the impact of anaemia on costs within the following patient cohorts: a. Emergency and elective procedures b. Laparoscopic, open and combined procedures c. Malignant and non-malignant diagnoses 3) Identify key patient and perioperative variables associated with increased costs and adverse patient outcomes to ascertain areas for improvement allowing the development of evidence-based guidelines with the ultimate goal of improving patient outcomes and efficiency of our health services.

Eligibility

Sex: Both males and femalesMin Age: 18 Yearss

Plain Language Summary

Simplified for easier understanding

Anaemia — a low level of red blood cells — is common in people preparing for major surgery. Research shows that patients going into surgery already anaemic are more likely to experience complications, stay in hospital longer, and cost the health system significantly more. However, the exact financial impact of pre-operative anaemia has not been well quantified in Australia. This retrospective study analyses data already collected from adult patients who had major abdominal surgery (colon, rectal, pancreatic, or liver operations) at Austin Hospital in Melbourne between 2010 and 2018. By linking pre-operative blood test results to actual hospital costs, the study aims to quantify just how much anaemia costs — in medications, intensive care, ward care, and total hospital expenses. This is a records-based study that does not enrol new patients. Eligible patients are those who had qualifying abdominal surgery lasting over two hours with at least one overnight stay at Austin Hospital during the study period. Pregnant patients are excluded.

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Interventions

Outcome data from the financial costing records of patients undergoing major abdominal surgery at Austin Health will be collected for the time periods between July 2010 and June 2018. To more clearly

Outcome data from the financial costing records of patients undergoing major abdominal surgery at Austin Health will be collected for the time periods between July 2010 and June 2018. To more clearly appreciate the financial burden associated with preoperative anaemia, we will select four types of subspecialty surgeries, each of which being associated with significant morbidity. These surgeries will include: • pancreaticoduodenectomy • major colonic resection • major rectal resections • liver resection surgery We will collect elective and emergent data from the above 4 surgeries using procedural ICD-10 codes 32003-01 Right hemicolectomy with anastomosis 32005-03 Laparoscopic extended right hemicolectomy with anastomosis 32003-03 Laparoscopic right hemicolectomy with anastomosis 32005-01 Extended right hemicolectomy with anastomosis 32004-01 Extended right hemicolectomy with formation of stoma 32000-03 Laparoscopic right hemicolectomy with formation of stoma 32004-03 Laparoscopic extended right hemicolectomy with formation of stoma 32000-01 Right hemicolectomy with formation of stoma 32006-00 Left hemicolectomy with anastomosis 32006-02 Laparoscopic left hemicolectomy with anastomosis 32006-03 Laparoscopic left hemicolectomy with formation of stoma 32006-01 Left hemicolectomy with formation of stoma 32009-00 Total colectomy with ileostomy 32012-01 Laparoscopic total colectomy with ileorectal anastomosis 32009-01 Laparoscopic total colectomy with ileostomy 32012-00 Total colectomy with ileorectal anastomosis 32004-02 Laparoscopic subtotal colectomy with formation of stoma 32005-02 Laparoscopic subtotal colectomy with anastomosis 32005-00 Subtotal colectomy with anastomosis 32004-00 Subtotal colectomy with formation of stoma 32000-02 Laparoscopic limited excision of large intestine with formation of stoma 32003-00 Limited excision of large intestine with anastomosis 32003-02 Laparoscopic limited excision of large intestine with anastomosis 32000-00 Limited excision of large intestine with formation of stoma 30414-00 Excision of lesion of liver 30415-00 Segmental resection of liver 30418-00 Lobectomy of liver 30421-00 Trisegmental resection of liver 30584-00: Pancreaticoduodenectomy with formation of stoma 32024-00 High anterior resection of rectum 32025-00 Low anterior resection of rectum 32026-00 Ultra low anterior resection of rectum 32028-00 Ultra low anterior resection of rectum with hand sutured coloanal anastomosis 32030-00 Rectosigmoidectomy with formation of stoma 32030-01 Laparoscopic rectosigmoidectomy with formation of stoma 32039-00 Abdominoperineal proctectomy 32047-00 Perineal proctectomy 32051-00 Total proctocolectomy with ileo-anal anastomosis 32051-01 Total proctocolectomy with ileo-anal anastomosis and formation of temporary ileostomy 32112-00 Perineal rectosigmoidectomy 92208-00 Anterior resection of rectum, level unspecified Patients records will reviewed for up for 30 days following discharge from the index admission.