The costs of preoperative anemia in hip joint revision surgery

Background Anemia is highly prevalent in patients before hip joint revision surgery (HJRS) and is associated with an increased complication rate. This paper is the first to investigate costs, real diagnosis-related group (DRG) revenues and case coverage of preoperative anemia in elective HJRS. Methods Medical data, transfusions, costs, and revenues of all patients undergoing HJRS at two campuses of the Charite -Universitatsmedizin Berlin between 2010 and 2017 were used for subgroup analyses and linear regressions. Results Of 1187 patients included 354 (29.8%) showed preoperative anemia. A total of 565 (47.6%) patients were transfused with a clear predominance of anemic patients (72.6% vs. 37.0%, p < 0.001). Costs (12,318euro [9027;20,044euro] vs. 8948euro [7501;11,339euro], p < 0.001) and revenues (11,788euro [8992;16,298euro] vs. 9611euro [8332;10,719euro], p < 0.001) were higher for preoperatively anemic patients and the coverage was deficient (-1170euro [-4467;1238euro] vs. 591euro [-1441;2103euro], p < 0.001). In anemic patients, case contribution margins decreased with increasing transfusion rates (p <= 0.001). Comorbidities had no significant economic impact. Conclusion Preoperative anemia and perioperative transfusions in HJRS are associated with increased treatment costs and a financial undercoverage for healthcare providers and health insurance companies. Concepts for the treatment of preoperative anemia (e.g. patient blood management) could reduce treatment costs in the medium term.