Comparison between spinal surgery blood transfusion services costs and associated treatment practices in the United States and Belgium

ABSTRACT Objective: This study assessed utilization and cost of allogeneic blood transfusion (ABT) associated with spinal surgery in the United States (US) and Belgium. Methods: A retrospective cohort of 292 864 spinal surgery inpatients in US hospitals was pooled with a cohort of 27 952 inpatients who had similar procedures in Belgian hospitals. Utilization and cost data were derived from hospital accounting systems. Costs were converted to US dollars. Descriptive and multivariate statistics were used to describe the factors associated with the use and cost of ABT. Missing data, confounding, and variable measurement error were addressed using standard approaches for observational studies. Results: US hospitalizations cost $12 044 (SD = 15 920) over 3.6 days compared to $4010 (SD = 3586) over 10.3 days in Belgium. Low molecular weight heparin was used by 78% of Belgian patients and 4% of US patients. Red blood cell utilization occurred in approximately 7% of patients from both countries; however US patients received 6 units compared to 3 units by Belgian patients. US patients spent 3.5 ( p < 0.0001) less days in hospital, 1.0 ( p < 0.0001) more days in an intensive care unit, used 64% more allogeneic blood (OR = 1.64, 95% CI 1.53–1.75), and incurred $13 647 ( p < 0.0001) more per hospitalization than Belgian patients. Conclusions: US patients used more blood products, had shorter hospital stays, and incurred greater costs than Belgian patients. Specialists as attending physicians were associated with lower utilization of ABT; this may be an administrative change that hospitals can implement to reduce utilization and costs.