Preoperative anemia linked to higher health care costs in gynecologic surgery

Preoperative anemia linked to higher health care costs in gynecologic surgery | Image Credit: © Dragana Gordic - © Dragana Gordic - stock.adobe.com.

Health care resource utilization and cost is significantly increased among patients with preoperative anemia when receiving elective gynecologic surgery, according to a recent study published in the Journal of Minimally Invasive Gynecology.¹

Multiple adverse postoperative outcomes have been associated with preoperative anemia during hysterectomy and myomectomy. These include surgical site infection, perioperative blood transfusion, prolonged hospital stay, and hospital readmission.

Despite these risks, 1 in 5 patients present with anemia during hysterectomy or myomectomy.² Additionally, evidence about health care costs associated with preoperative anemia remains lacking.¹

To determine health care costs linked to preoperative anemia among patients receiving elective gynecologic surgery, investigators conducted a retrospective, population-based matched cohort study. Data was obtained from a government administered single-payer health care system in Ontario, Canada.

Participants included adult women receiving hysterectomy or myomectomy for benign indications from January 1, 2013, to December 31, 2020. Those with missing or invalid health card number, sex, or age were excluded from the analysis, alongside those with a death date before the procedure date or not residing in Ontario, Canada.

The primary exposure was preoperative anemia within 60 days prior to surgery, with anemia determined by hemoglobin value below 12 g/dL. Health care costs were calculated as the primary outcome from the perspective of the Ontario Ministry of Health.

Costs linked to surgeries, emergency room visits, hospitalizations, primary care visits, outpatient prescription drugs, laboratory tests, and physicians’ services were evaluated. An existing cost algorithm at the research institute ICES was used to estimate these costs.

Covariates included age, comorbidities within 2 years before index procedure, Charlson comorbidity index, history of diabetes or chronic obstructive pulmonary disease, transfusion within 6 months before the procedure, cancer within 5 years before the procedure, and quintile of neighborhood income. Surgical and institutional covariates were also obtained.

There were 59,270 patients with a recorded hysterectomy or myomectomy included in the final analysis. Anemia was reported in 19.9% while 80.1% did not have anemia before surgery. Nonanemic patients were more often older, living in rural Ontario, and not reporting a transfusion within 6 months before surgery than their anemic counterparts.

Invasive hysterectomy was also more common in nonanemic patients vs anemic patients. There were 10,103 anemic patients successfully matched to the same number of nonanemic patients.

Anemic patients had a mean health care cost of $6134.88 ± $2782.38. In comparison, nonanemic patients had a reduced cost at $6009.97 ± $2423.27. A significant increase in total health care cost of $124.91 per person was reported in the anemic group vs the nonanemic group.

Significantly increased costs were also reported in the anemia group when utilizing a generalized linear model. Anemia was associated with a 2.08% increase in cost.

Of patients, 9041 received hysterectomy while 1062 received myomectomy. When restricting the analysis to hysterectomy alone, the mean difference in cost among anemic patients vs nonanemic patients was $117.67 per person, indicating a significant increase. For myomectomy alone, this increase was not significant at $186.61 per person.

These results indicated significant increases in health care costs from elective gynecologic surgery when patients present with preoperative anemia. Investigators concluded it is important to address preoperative anemia as a quality metric in health care.

References

1. Murji A, Lam M, Shirreff L, Lipscombe L, Isaranuwatchai W.Preoperative anemia prior to gynecologic surgery is associated with increased healthcare costs. Journal of Minimally Invasive Gynecology. 2024;31(9):778-786. doi:10.1016/j.jmig.2024.05.022
2. Murji A, Lam M, Allen B, et al. Risks of preoperative anemia in women undergoing elective hysterectomy and myomectomy. Am J Obstet Gynecol. 2019;221(6):629.e1-629.e18. doi:10.1016/j.ajog.2019.07.018