Perioperative blood loss during total hip arthroplasty (THA) increases patient morbidity, length of stay (LOS), medical resource use (MRU), and costs. Minimizing blood loss may reduce postoperative anemia, the need for blood transfusions, and the increased risk of infections and longer hospital stays associated with blood transfusions. Pharmacologic agents and bipolar sealer devices can minimize perioperative bleeding. A retrospective, comparative cohort study in the US hospital setting was conducted to assess MRU and associated costs and the incidence of transfusion and complications among patients undergoing THA with or without the use of a bipolar sealer. Using a nationwide all-payer hospital administrative database, THA procedures from January 1, 2008, to March 31, 2011, were identified using International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 81.51. The bipolar sealer cohort (n=2683) and matched control cohort (n=2683) had a mean age of 65 years from 38 hospitals. The 2 groups had similar incidences of pre-operative anemia and medical comorbidities. Patients in the bipolar sealer group required significantly fewer blood transfusions (21.3% vs 23.8%; P=.0286) and had significantly lower incidence of hematomas (0.2% vs 0.9%; P=.0015) and significantly shorter LOS (2.90 vs 3.31 days; P<.0001) overall. The bipolar sealer group had higher supply costs, which were offset by reduced hospital inpatient room and board and operating room costs; there was no significant difference in total hospital costs between the 2 groups ($18,937 vs $18,734; P=.56). A bipolar sealer decreases postoperative blood transfusions and LOS during primary THA without increasing total hospital costs.
The authors are from Covance Market Access Services Inc (SJA, CIT), San Diego, California; Covance Market Access Services Inc (RB), Gaithersburg, Maryland; and the Center for Joint Preservation and Reconstruction (RP, MAM), Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Dr Pivec has no relevant financial relationships to disclose. Dr Ackerman, Ms Tapia, Ms Baik, and Dr Mont are consultants for Medtronic.
This study was sponsored by Medtronic Advanced Energy, LLC, Portsmouth, New Hampshire.
The authors thank Robert Swain, PhD, and Gregory French for providing and ensuring the accuracy of information concerning the Aquamantys bipolar sealer.
Correspondence should be addressed to: Michael A. Mont, MD, Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W Belvedere Ave, Baltimore, MD 21215 ( firstname.lastname@example.org).
Received: November 01, 2013
Accepted: November 25, 2013