Patients with hemophilia A or von Willebrand disease undergoing anterior cruciate ligament (ACL) reconstruction had rates of postoperative complications and ACL reinjuries that were not significantly different from those control patients. However, the cost of health care utilization was significantly greater for the hemophilia A and von Willebrand disease patients, according to a large retrospective database study published online in The Knee.
All patients who underwent an ACL reconstruction from 2010 to 2014 in a large commercial database were assessed. Patients with hemophilia A, hemophilia B, and von Willebrand disease were identified. Patient demographics, cost of surgery, blood product use, concomitant injuries, repeat ACL injury, complications, and various operative variables were collected.
A total of 33 patients with hemophilia A, 3 with hemophilia B patients, 63 with von Willebrand disease and 103,478 control patients who had ACL reconstruction were compared, according to Connor Zale, MD, and colleagues at Penn State Hershey (Pa.) Medical Center.
Similar outcomes, higher costs
Complications – including length of hospital stay, postoperative hemorrhage within 14 days after surgery, infection rates within 90 days of surgery, lysis of adhesions or manipulation under anesthesia within 90 days of surgery, concomitant injuries to the knee, additional ACL injury within 1 year of surgery, deep-vein thrombosis, and pulmonary embolism – were not statistically different between the hemophilia/von Willebrand cohorts and the control group, according to the researchers.
However, surgery and postoperative care were costlier in the hemophilia A and von Willebrand cohorts. Total health care utilization within 30 days of ACL reconstruction was significantly more expensive for patients with hemophilia A ($25,982) and those with von Willebrand disease ($16,445), compared with those among controls ($12,887). In addition, the total health care utilization costs within 90 days of ACL reconstruction were significantly higher for patients with hemophilia A ($30,310) and those with von Willebrand disease ($20,355), compared with those among controls ($14,564), with all P values less than .001.
None of the patients with hemophilia A or those with von Willebrand received blood products perioperatively, had a known major hemarthrosis, or were readmitted within 30 or 90 days, the authors noted, adding that this finding differs from previous studies. The authors speculated that, since no blood products were administered and there was no significant difference in postoperative hemorrhage, the patients with hemophilia A were preoperatively optimized for an acceptable prothrombin time and international normalized ratio and/or were more effectively managed postoperatively.
“Many surgeons may be fearful of performing an ACL reconstruction on those with hemophilia A, hemophilia B, and von Willebrand disease due to concerns over risk of a major hemarthrosis and other complications postoperatively. This study observed that hemophilia A and von Willebrand disease patients who underwent an ACL reconstruction had rates of postoperative complications that were not statistically different than those who underwent ACL reconstructions and did not have a known hypocoagulable condition,” the researchers concluded.
The authors reported that they had no potential conflicts of interest to disclose.
SOURCE: Zale C et al. Knee. 2020;27(6):1729-34.