Impact of preoperative anemia on hospital costs in children and adolescents undergoing pediatric spinal deformity surgery.

Background context: Preoperative anemia is associated with the need for red blood cell (RBC) transfusion and extended hospital stays in pediatric patients undergoing spinal deformity surgery.

Purpose: This study sought to identify excess hospital costs associated with preoperative anemia in this population.

Design: Retrospective review of linked procedure records from prospectively maintained institutional databases.

Patient sample: Patients aged 2 to 18 years old who underwent posterior spinal fusion surgery at our institution from 2017 to 2023 were identified through procedure-related data collected as part of the National Surgical Quality Improvement Program and Pediatric Health Information Systems databases.

Outcome measures: The primary outcome measure was total hospital costs, as derived from billed services and the hospital's department level costs-to-charge ratios, with RBC transfusion as a mediating outcome.

Methods: Linear regression estimated the association between preoperative anemia and increased hospital costs, adjusting for age, sex, American Society of Anesthesiologists physical status classification, number of spinal levels fused, and surgical duration. The unified framework for mediation and interaction identified whether RBC transfusion was a significant mediator of this association.

Results: Of 672 patients, 10.6% (n=71) were anemic on preoperative testing. Higher median total hospital costs were seen for those with preoperative anemia than those without ($49,370 vs. $41,044; p<.001). Linear regression on log-transformed cost data indicated that those with anemia had 18.0% (95% CI: 4.5%-33.2%; p=.008) higher total hospital costs after adjustment for covariates, highlighting 95% confidence in a cost excess of at least $2,448 in anemic patients. RBC transfusion was more common in anemic patients (63.4% vs. 46.8%, p=.008) and significantly mediated the observed association with costs.

Conclusions: Preoperative anemia is independently associated with increased healthcare costs during the surgical treatment of spinal deformity in children, with anemic patients incurring thousands of dollars of additional costs driven in part by those associated with RBC transfusion. Depending on the expense and efficacy of hemoglobin optimization strategies, these findings highlight the potential for a cost-effective intervention to treat preoperative anemia in vulnerable populations.