Two used hospital or administrative data; two used data from Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE),34 a registry of patients with unstable angina receiving antithrombotic agents; one used the HCUP-NIS; and the last used MPSMS data.35,36,37,38 This mix of data resulted in a mix of patient populations studied—from all Medicare beneficiaries to adult surgical or cardiology patients—and methods used to identify HAC cases, from ICD-9 codes to reported dosing and surveillance. Based on three studies reporting cost data, we estimated the additional cost for hospital-acquired pressure ulcers to be $14,506 (95% CI: -$12,313 to $41,326), whereas excess mortality, based on three studies, was estimated at 0.041 (95% CI: 0.013 to 0.093) per HAC case (meaning for every 1,000 pressure ulcer cases, there are 41 excess deaths). Primary healthcare costs and antibiotic costs accounted for 14% and 6%, respectively. More details on underlying mortality, including sources for each estimate, can be found in Appendix B. Of note, this calculation assumes all OBAE-related deaths happen in the hospital setting, which, if not true, would mean excess mortality and percentage of inpatient maternal deaths due to OBAE are overestimates. Accessibility *No studies could be used in our relative risk-based meta-analysis methods, so estimates were produced from an alternative method described in more detail in the OBAE section below. Our systematic literature review found that there is a gap in current literature to examine the impact of maternal adverse events on hospital mortality in the United States. It is possible that treating high-risk surgical patients medically will prove to be more cost-effective than repeated operations. Martin VT, Abdullahi Abdi M, Li J, Li D, Wang Z, Zhang X, Elodie WH, Yu B. Med Sci Monit. Another caution: we were only able to include studies involving the administration of opioids and, thus, this estimate may not be generalizable to anticoagulants, hypoglycemic agents, or adverse drug events involving other drug classes. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. Association of Postoperative Infection With Risk of Long-term Infection and Mortality. We believe this is due to the low number of articles we were able to include. Using a total of 3,978,497 live-births in the U.S. in 2015, the total number of cases with maternal adverse events were estimated as: 27,372 (95% CI: 10,225 to 44,480). These estimates do not include related costs (e.g., days of lost work) or costs of a readmission resulting from the HAC. Most cases of healthcare-acquired surgical site infections (SSI) appear after discharge from hospital (); rates of postdischarge SSI between 2% and 14% have been reported ().Little is known of the costs of postdischarge SSI, but 2studies suggest that they are large (3–5) with health services and patients incurring costs and subsequent production losses. We define additional cost as the incremental costs to the hospital for the inpatient stay attributable with the HAC of interest. Agency for Healthcare Research and Quality, Rockville, MD. 5600 Fishers Lane Generalizability of patient population studied to U.S. populations. Surgical site infections are defined as infections that occur 30 days after surgery with no implant, or within 1 year if an implant is placed and infection appears to be related to surgery. The incidence of postdischarge surgical site infection was 8.46%. The study with the lowest cost estimate was also the most recent study, using data from 2006 through 2012.42 Overall, most of the studies included in meta-analysis focused on specific patient subpopulations including pediatric patients, intensive care unit patients, and those with specific conditions (e.g., epilepsy, cancer). This left us with only one study examining the risk of maternal mortality for adverse events acquired in hospitals, and the adverse event was obstetrical trauma only.54 Further, this study found no increase in mortality for obstetrical trauma. Variability in individual study estimates. The majority of SSIs are largely preventable and evidence-based strategies have been available for years and implemented in many hospitals. Only two studies were explicit about the types of infection included in their definition of SSI. The most common infections, surgical site infections, which happen in about one out of every 50 operations, cost around $21,000 each to treat. Methods We … Based on seven studies reporting cost data, we estimated the additional cost for hospital-acquired CLABSI to be $48,108 (95% CI: $27,232 to $68,983), whereas excess mortality, based on five studies, was estimated at 0.15 (95% CI: 0.070 to 0.027) per HAC case (meaning for every 1,000 in-hospital CLABSI cases, there are 150 excess deaths). All patients in the considered studies were adult (ages >18) except for one, which studied pediatric patients exclusively (age 1–17 years)39 Although all studies reported sample size either in terms of number of cases or number of patients with CAUTI, we found wide ranges of sample sizes from 18 in 6-year pooled data on colorectal resection patients40 to 105,113 in 10-year pooled data on surgical oncology patients.41 These discrepancies were largely due to the source of data and definition of populations used in each study. That is, the costs associated with superficial incisional SSIs are relatively low, but increase with deep SSI, and especially when organ or space infection is present. Based on three studies reporting cost data, we estimated the additional cost for hospital-acquired falls to be $6,694 (95% CI: -$1,277 to $14,665), while excess mortality, based on one study, was estimated at 0.050 (95% CI: 0.035 to 0.070) per HAC case (meaning for every 1,000 falls cases, there are 50 excess deaths). These bacteria … https://www.ahrq.gov/hai/pfp/haccost2017-results.html. In Exhibit 7, we provide estimates for the additional costs associated with each HAC. Attributable cost and extra length of stay of surgical site infection at a Ghanaian teaching hospital Infection Prevention in Practice, Vol. 2014 Jun;149(6):575-81. doi: 10.1001/jamasurg.2013.4663. For instance, some studies involved all inpatient populations,37,42 yet the majority of studies focused on specific medical and/or surgical conditions (e.g., surgical oncology in Sammon 2013; colorectal resection in Byrn 2015).40,41 Additionally, the scope of the studies varied, from hospitals in a single network using data from EMRs40,42 to nationally representative samples, with four studies using HCUP-NIS,39,41,43,44 one using MedPAR claims,45 and one using Cardinal Health MedMined data.46 These factors potentially influenced our cost and mortality estimates, as exhibited in the large variations in individual estimates. For this calculation, we took the number of inpatient deaths due to maternal adverse events (i.e., 134 as calculated earlier) and divided by the total number of inpatient maternal deaths in the United States. EFFECT OF SURGICAL SITE INFECTIONS Of all the HAIs in the United States, surgical site infections (SSIs) are the most common and costly, accounting for 20% of all HAIs, with an estimated annual national cost of $3 to $5 billion.7 That estimate accounts for only those patients who survive. 1-4 Treatment of SSIs often includes long courses of antibiotics, months of physical therapy, readmissions to the hospital, and reoperations. Adverse impact of surgical site infections in English hospitals. Exhibit 7. Some of the factors we considered included: More details on each of the studies included in each estimate are provided in Appendix D. Forest plots for each additional cost and excess mortality meta-analysis for each HAC can be found in Appendix E. Based on two studies reporting cost data, we estimated the additional cost for hospital-acquired ADE to be $5,746 (95% CI: -$3,950 to $15,441), whereas excess mortality, based on six studies, was estimated at 0.012 (95% CI: 0.003 to 0.025) per HAC case (meaning for every 1,000 in-hospital ADE cases, there are 12 excess deaths). One study counted all superficial, deep, and organ-space SSIs, whereas the other included only deep and organ-space infections.67,68 The data sources used and cost estimates found in both of these studies did not vary from those in the other included studies. Most of the studies included in our estimates reported on adult inpatient populations,65,69,81,82,83,84,85 with two studies considering patients of all ages86,87 and one study focused on pediatric patients exclusively.39 Sample size varied greatly in terms of total population, number of cases identified, and incidence rate of events. The need to treat SSIs places a severe financial strain on health care resources. For each HAC, we list the number of studies, the range of relative risk of death estimates from those studies, our pooled meta-analysis relative risk estimate, underlying mortality in the population, and finally, excess mortality and 95% CI for whether the estimated excess mortality is statistically different from zero. Based on six studies reporting cost data, we estimated the additional cost for hospital-acquired CAUTI to be $13,793 (95% CI: $5,019 to $22,568), whereas excess mortality, based on four studies, was estimated at 0.036 (95% CI: 0.004 to 0.079) per HAC case (meaning for every 1,000 in-hospital CAUTI cases, there are 36 excess deaths). In total, we screened nearly 4,000 articles for possible inclusion in meta-analysis—the majority of which were screened out based on a title and abstract review (3,038 of 3,979, or 76.4 percent, were eliminated). For example, the study with the lowest cost estimate ($11,778) involved chart review at a single medical center and had one of the lowest number of cases (N=186) among all included studies.67 For mortality, studies with the largest and smallest estimates (relative risk of 6.18 and 1.79, respectively) both used close to 10 years of data from the HCUP-NIS database, but the study with the smallest estimate included a much larger population of surgical patients.41,69. We discuss why previous studies might have overstated costs. Other studies on the cost associated with surgical site infections have taken place in contexts that are quite different from the situation in Ghana. This enabled them to use VAP definitions that incorporated clinical information such as laboratory testing that closely mirror the QSRS definitions. Telephone: (301) 427-1364, https://www.ahrq.gov/hai/pfp/haccost2017-results.html, AHRQ Publishing and Communications Guidelines, Healthcare Cost and Utilization Project (HCUP), Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase, Funding Opportunities Announcement Guidance, AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Public Access to Federally Funded Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, Comprehensive Unit-based Safety Program (CUSP), Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions, U.S. Department of Health & Human Services. Study results that report hospital charges have been transformed to costs using cost-to-charge ratios, a well-established method in the literature.28 All costs are reported in 2015 dollar amounts and on a per-HAC-case basis. Background: Clipboard, Search History, and several other advanced features are temporarily unavailable. First, we estimated the total number of deaths due to maternal adverse events based on National Vital Statistics Data and CDC Pregnancy Mortality Surveillance Systems. The combined direct and indirect costs of treating SSIs may be extremely high. This is very large underestimate given the lack of or incomplete data on common infec- Underlying mortality values were taken from the literature and reflect our best estimate of the mortality rate for the population at risk for each of the HACs. Internet Citation: Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. 2017 May;96(1):1-15. doi: 10.1016/j.jhin.2017.03.004. The confidence interval for our additional cost estimate overlaps zero, indicating that the plausible range for the true estimate (with 95% confidence) includes no additional costs related to ADE. reported that across multiple surgical specialties, the direct total healthcare cost of developing an SSI was $1,084,639, which was mainly attributable to prolonged hospitalization (37%) and other hospital costs (43%). Prevention and treatment information (HHS). From the product of combining the number of live births, the maternal mortality rate, the maternal mortality rate related to pregnancy, and the percent of pregnancy-related deaths due to adverse events, we estimated the annual number of inpatient deaths due to maternal adverse events in the United States was 134, based on the assumption that all of the OBAE-related deaths happen in the inpatient setting. Proportion of overall maternal deaths related to pregnancy: 38.2 percent (2011-2013 data). The rate of surgical site infection varies depending on the type of procedure, with rates of less than 1% for orthopaedic procedures and rates of over 10% for large bowel surgery [ … Unable to load your collection due to an error, Unable to load your delegates due to an error. Patient population studied related to the general population at risk for the HAC. 2005 Jun;60(2):93-103. doi: 10.1016/j.jhin.2004.10.019. For example, one study that focused on Medicare beneficiaries and multiple drug classes reported a relative risk more than double that of studies involving all adults and one drug class.35. The majority of VAP studies included in both cost and mortality estimates were conducted among ICU patients with only three studying patients outside of these units, one looking at cancer patients, and another examining all hospitalized patients.41,74,75 Two of the studies included in the mortality estimate reported on pediatric populations, one from a PICU and the other a NICU.76,77 Most VAP studies drew data from hospital medical records or databases that combined records from several hospitals. There was significant variability in reported mortality between studies, due mainly to variation in patient population and data source. Four addressed costs related to VTE leading to a pooled estimate of $17,367 additional costs for each VTE event. In addition, given the low incidence rate of maternal adverse events (1 percent) and low maternal mortality rate (0.02 percent), data analysis would require a national or a combination of multi-state databases across multiple years in order to achieve a large enough sample size to detect any increased risk. That is, the costs associated with superficial incisional SSIs are relatively low, but increase with deep SSI, and especially when organ or space infection is present. The excess mortality estimate only represents the results of one study that used raw numbers found in the HCUP-NIS and should be treated with caution.53 The dearth of literature on excess mortality may be due to the difficulty in finding reliable sources of data on injuries linked exclusively to in-hospital falls. On average, 6.4 studies were included in estimates for infectious HACs, whereas only an average of three studies were available for non-infectious HACs. These variations were largely due to the definition of population applied in individual studies. While costs of an SSI vary widely based on the degree of infection and the site of surgery, the estimated average cost of an SSI can be more than $25,000, increasing to more than $90,000 if the SSI involves a prosthetic implant. 3 Overall, SSIs cost the US healthcare system an estimated $3.5 to $10 billion annually. Surgical site infections are dangerous, costly, and preventable, and everyone in ambulatory surgery centers has a role in preventing them. It is possible that the relatively higher risk of mortality from these HACs is due in part to the underlying morbidity in the types of populations vulnerable to such conditions. The direct costs of SSI include a longer hospital stay, readmission, outpatient and emergency visits, further surgery, and prolonged antibiotic treatment. Hospital-Acquired Condition (HAC) Reduction Program What is the Hospital-Acquired Condition (HAC) Reduction Program? Two studies used lab results, and one used the CDC-NHSN to define cases.42,47,48 CLABSI definitions used in cost studies also varied from clinical surveillance criteria to ICD-9-based definitions; however, these differences did not seem to influence the resulting attributable cost estimates. Estimated 157,500 SSI infections in U.S. per year (2) SSI is the most costly HAI type – estimated annual cost of $3.3 billion, and is associated with nearly 1 million additional inpatient-days (3,4) Methods of the included studies ranged from analysis of national hospital discharge data to reviews of a single hospital’s CDI rates. Analytic methods also varied considerably, as studies using a matched control group tended to be more comparable to cases on observed covariates and may be a better approximation of attributable cost and/or mortality than those studies using a pooled control sample. Eleven studies were included in our review for VTE. Surgical site infections have been shown to account for up to 16% of all healthcare-associated infections. infections, 4902 Clostridium difficile infections, 3946 surgical site infections, 1962 respiratory infections in acute stroke patients and 1100 hospital-onset Staphylococcus aureus bacterae-mia. We identified six studies providing estimates of costs and/or mortality for hospital-acquired pressure ulcers. doi: 10.7759/cureus.5183. the third section, the annual national cost estimates . doi: 10.1089/sur.2002.3.s1-37. The HAC Reduction Program encourages hospitals to improve patients’ safety and reduce the number of conditions people experience from their time in a hospital, such as pressure sores and hip fractures after surgery. Review of current practice and guidelines. Although 400,000 hip and knee joint replacement procedures were completed in 2014, accounting for over $7 billion in hospitalizations [ 11 ], quality of care and costs still vary widely and surgical site infections (SSIs) continue to pose a significant burden to patients and the healthcare system. Overall maternal mortality rate: 23.8 per 100,000 live births (2014 data). In this section, we briefly discuss these considerations for each HAC. Kimberly-Clark, as part of its healthcare-associated infections website, provides a free, downloadable surgical site infection cost of infection savings calculator.. 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