E. Aguayo1, K. L. Bailey1, Y. Seo1, A. Mantha2, V. Dobaria1, Y. Sanaiha1, P. Benharash1 1University Of California At Los Angeles,Department Of Surgery/ Division Of Cardiac Surgery,Los Angeles, CA, USA 2University Of California – Irvine,School Of Medicine,Orange, CA, USA
Introduction:
Heparin is routinely used in many cardiovascular procedures to prevent thrombosis. An antibody mediated process, heparin-induced thrombocytopenia (HIT) occurs in a small subset of patients exposed to heparin. While hemorrhage is thought to be rare in HIT, the incidence of stroke, pulmonary embolism, and deep vein thrombosis dramatically increase. While some have suggested a recent increase in the incidence of HIT, data on the impact of HIT on costs and length of stay (LOS) after cardiac surgery is generally lacking. The present study aimed to assess national trends in the incidence and resource utilization associated with HIT in cardiac surgical patients.
Methods:
A retrospective cohort study was performed identifying adult cardiac surgery patients (≥ 18 years) with a diagnosis of HIT were identified using the 2009-2014 National Inpatient Sample (NIS) Database and International Statistical Classification of Diseases and Related Health Problems (ICD9) codes. In hospital mortality and GDP-adjusted cost were evaluated using hierarchical linear models adjusting for socioeconomic, demographic and comorbidity measured by Elixhauser Index.
Results:
Of the 3,985,878 adult cardiac surgery patients, 16,610 (0.42%) had HIT as a primary diagnosis with no trend over the study period. Compared to those without the diagnosis, HIT patients were on average older (67.1 vs 65.1, p<0.001), insured by Medicare (62% vs 52%, p<0.001), and had a higher Elixhauser comborbidity index (4.48 vs. 3.75, p<0.001). HIT was associated with significantly longer index LOS (19.1 vs 10.6 days, p<0.001) and higher hospitalization costs (91,977 vs $52,090, p<0.001). After adjustment for baseline differences, HIT was independently associated with increased risk of death (OR 2.72, 95% CI: 2.41-3.06), stroke (OR 2.12, 95% CI: 1.72-2.62), deep venous thrombosis (OR: 8.63, 95% CI: 7.60-9.80), and pulmonary embolism (OR: 5.43, 95% CI: 4.55-6.48).
Conclusions:
Based on this national analysis of adult cardiac surgical patients, HIT disproportionately affected those with government sponsored health insurance. The presence of HIT was associated with a significantly longer LOS, higher costs and comorbidities. The incidence of serious complications such as stroke, DVT, and PE more than doubled in HIT patients. These findings have significant implications in the era of value-based healthcare delivery. In addition to reducing unnecessary exposure to heparin, proper diagnosis and treatment is essential for favorable outcomes in these patients.
