2019 Oct 31;13(5):423-428. doi: 10.14444/6057. Internet Citation: Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. Total inpatient maternal deaths is calculated from the total number of live births, overall mortality rate, and percentage of maternal mortality occurring in the inpatient setting (based on the literature, estimated to be 62 percent).63 Thus, we estimated 23 percent of maternal inpatient deaths are due to OBAE. The economic costs of surgical site infection. Data on falls related to other health care settings, such as nursing homes, were not included in our analysis. Objective To determine the change in hospital profit due to SSIs.. Design Retrospective study of data from January 1, 2007, to December 31, 2010.. Based on nine studies reporting cost data, we estimated the additional cost for hospital acquired CDI to be $17,260 (95% CI: $9,341 to $25,180), whereas excess mortality, based on 13 studies, was estimated at 0.044 (95% CI: 0.028 to 0.064) per HAC case (meaning for every 1,000 in-hospital CDI cases, there are 44 excess deaths). Surgical site infection (SSI) continues to represent a significant portion of healthcare-associated infections because of their impact on morbidity, mortality, and cost of care. Much of the literature, which was screened out of our meta-analysis, dealt with one of two topics: 1) studies reported on cost and/or mortality resulting from admissions due to a fall in the community and 2) articles studied the impact of fall-prevention programs and protocols on the incidence of in-hospital falls. The estimated attributable costs of non-infectious HACs are generally less than those of infectious HACs, with only VTE ($17,367) and pressure ulcers ($14,506) generating an estimated additional cost in the range of the infectious HACs. Dividing the number of pregnancy-related maternal deaths due to adverse events calculated in step one, by the total number of maternal adverse events calculated in step two, we arrive at an estimate of 0.005 (95% CI: 0.003 to 0.013) for excess mortality due to OBAE (meaning for every 1,000 OBAE cases, there are 5 excess deaths). 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. The incidence of postdischarge surgical site infection was 8.46%. 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. Summary of meta-analysis additional cost estimates. While this may be a more relevant source of outcomes for falls specifically, based on articles found during screening, literature containing usable cost and mortality data is still limited for these other settings as well and may still face the same limitation of differentiating between falls leading to an admission and falls occurring in the institution. 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. The majority of SSIs are largely preventable and evidence-based strategies have been available for years and implemented in many hospitals. 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. These HACs tend to occur in sicker populations with an already increased risk for mortality. Based on four studies reporting cost data, we estimated the additional cost for hospital-acquired VTE to be $17,367 (95% CI: $11,837 to $22,898), whereas excess mortality, based on nine studies, was estimated at 0.043 (95% CI: 0.040 to 0.078) per HAC case (meaning for every 1,000 VTE cases, there are 43 excess deaths). Review of current practice and guidelines. Martin VT, Abdullahi Abdi M, Li J, Li D, Wang Z, Zhang X, Elodie WH, Yu B. Med Sci Monit. This is very large underestimate given the lack of or incomplete data on common infec- Among those conditions, hemorrhage/blood transfusion is the most commonly acquired condition (137 to 1,044 per 100,000 deliveries), followed by eclampsia/hypertensive complications (48 to 63 per 100,000 deliveries), and infection/sepsis (17 to 33 per 100,000 deliveries). 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. According to datafrom AHRQ, more than 10 million patients undergo We discuss why previous studies might have overstated costs. Privacy, Help Individual studies produced a broad range of cost estimates for CLABSI, ranging from $18,000 to more than $90,000. Two of the cost studies and two mortality studies used national databases (HCUP-NIS); however, all four of these focused on specific patient subpopulations for analysis. 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. In 2018/19, 201 NHS hospitals and 8 Independent Sector (IS) NHS treatment centres submitted surveillance data for 132,254 surgical procedures to the PHE Surgical Site Infection (SSI) Surveillance Service; across 17 surgical categories 1,183 SSIs were Only studies of single hospitals or local hospital networks reported consequences of CLABSI for a general inpatient population. Of note, CLABSI has the highest estimate for both additional cost and excess mortality. Cureus. According to an investigative study written by scholar and orthopedic surgeon Joshua A. 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. 2014 Jun;149(6):575-81. doi: 10.1001/jamasurg.2013.4663. Patient population studied related to the general population at risk for the HAC. 1 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). An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care. 8600 Rockville Pike The cost of SSIs increases with the depth of the infection. Indirect costs, which are difficult to quantify, include lost productivity of the patient and family and a temporary or permanent decline in functional or mental capacity. It is possible that treating high-risk surgical patients medically will prove to be more cost-effective than repeated operations. It is possible that these HACs have been met with extensive in-hospital tracking and prevention efforts, compared to the other HACs in our study. 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. The estimated annual incidence of SSIs in the U.S. ranges from 160,000 to 300,000, and the estimated annual cost ranges from $3.5 billion to $10 billion. Key points . The cost of hospitalisation was, on average, ₩2,153,964 higher in patients with SSI, compared to patients with no SSI (P = 0.045). AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. The three studies involved in our estimate of additional costs use either a national sample of orthopedic surgery patients or a small sample of adult inpatients specific to a hospital. Percentage of pregnancy-related deaths due to adverse events: 37.1 percent (2011-2013 data). 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). They also differed in the conditions that were counted as maternal adverse events (all four studies included infection/sepsis, hemorrhage/blood transfusion, and eclampsia/hypertensive complications; three studies included amniotic fluid embolisms and anesthesia complications; two studies included intracranial injuries and internal injuries of thorax, abdomen, and pelvis; one study included iatrogenic events. 2019 Jul 21;11(7):e5183. The objective of this study was to assess the cost and health‐related quality of life impact of SSI, from the perspective of a large teaching hospital in England. Studies varied in their source of cost data, from national claims databases (i.e., HCUP-NIS) to hospital administrative data systems. Based on two studies reporting cost data, we estimated the additional cost for hospital-acquired OBAE to be $602 (95% CI: -$578 to $1,782). Surgical site infections (SSI) substantially increase costs for healthcare providers because of additional treatments and extended patient recovery. 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. Excess mortality is defined as the number of additional deaths due to a given HAC and shown as the number of deaths per HAC case. Would you like email updates of new search results? Data were collected from surgical patients in the hos-pital and on 4 occasions postdischarge. This additional cost estimate should be used with caution because it does not include a comprehensive set of maternal adverse events. The datasets used by our set of articles for these estimates are mixed. Epub 2019 Apr 3. There are about four C. difficile infections for every 1,000 patients who spend a day in the hospital, making them the second most common kind of infection, and those cost about $11,000 each to treat. Background: Surgical site infections (SSIs) are associated with increased morbidity and mortality. 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. Other studies on the cost associated with surgical site infections have taken place in contexts that are quite different from the situation in Ghana. Methods We … 5600 Fishers Lane The HACs with the highest excess mortality were CLABSI and VAP. Prevention and treatment information (HHS). 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. Surgical Site Infections Based on five studies reporting cost data, we estimated the additional cost for hospital-acquired SSI to be $28,219 (95% CI: $18,237 to $38,202), whereas excess mortality, based on three studies, was estimated at 0.026 (95% CI: 0.009 to 0.059) per HAC case (meaning for every 1,000 SSI cases, there are 26 excess deaths). For example, no data on costs associated with infections were found, and such infections could be costly. 2020 Dec 11;26:e927052. Preoperative Intranasal Decolonization with Topical Povidone-Iodine Antiseptic and the Incidence of Surgical Site Infection: A Review. 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). Fernandez LG, Matthews MR, Sibaja Alvarez P, Norwood S, Villarreal DH. 3 Overall, SSIs cost the US healthcare system an estimated $3.5 to $10 billion annually. In this section, we briefly discuss these considerations for each HAC. 2014 Oct;149(10):1045-52. doi: 10.1001/jamasurg.2014.346. 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. 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. Furthermore, SSIs constitute a financial burden and negatively impact on patient quality of life (QoL). These bacteria … Our estimate of additional costs associated with OBAE is based on two studies reporting on a subset of conditions included in the maternal adverse event definition. More than half of the studies included in the mortality estimate used regression modeling techniques to estimate mortality due to VAP; however, there were a large minority (four studies) reporting only deaths for VAP patients and a matched comparison group. AIM: To identify the burden of (deep) SSIs in costs and disability-adjusted life years (DALYs) following colectomy, mastectomy and total hip arthroplasty (THA) in the Netherlands. Closed Incision Negative Pressure Therapy: Review of the Literature. The estimated costs of managing SSI differ widely, from less than dollar 400 per case for superficial SSI to more than dollar 30,000 per case for serious organ or space infections. 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. This enabled them to use VAP definitions that incorporated clinical information such as laboratory testing that closely mirror the QSRS definitions. One study (by Bates, et.al) used for our cost estimate employed data from the late 1980s to the early 1990s.49 In addition, many more recent studies that address additional cost due to in-hospital falls base their costs calculations on the Bates article.49 Costs associated with prevention efforts, as well as direct and long-term costs of care after a fall that requires hospitalization, have been measured but are outside the scope of this analysis.50,51,52. Because many of these studies were conducted in single institutions or small groups of hospitals, the number of cases was small in each study. Based on five studies reporting cost data, we estimated the additional cost for hospital-acquired VAP to be $47,238 (95% CI: $21,890 to $72,587), whereas excess mortality, based on 10 studies, was estimated at 0.14 (95% CI: -0.11 to 0.73) per HAC case (meaning for every 1,000 VAP cases, there are 140 excess deaths). Analytic strategies used to assess additional cost and/or excess mortality. Overall maternal mortality rate: 23.8 per 100,000 live births (2014 data). 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. Coello R, Charlett A, Wilson J, Ward V, Pearson A, Borriello P. J Hosp Infect. We believe this is due to the low number of articles we were able to include. In Exhibit 7, we provide estimates for the additional costs associated with each HAC. The formula used to estimate excess risk and sources for underlying mortality estimates are provided in Appendix B. Exhibit 8. Urban: “Surgical site infections may account for as much as $10 billion annually in direct and indirect medical costs”. According to the new JAMA report, surgical site infections contribute the most to overall costs, accounting for more than a third of the total. 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). Exhibit 7. In contrast, the literature contained far fewer usable studies for falls (3 for costs and 1 for mortality) and OBAE (2 for costs and none for mortality). 2005 Jun;60(2):93-103. doi: 10.1016/j.jhin.2004.10.019. 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). 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. How Does Measuring Cost-Benefit Currently Impact Infection Control? The direct costs of SSI include a longer hospital stay, readmission, outpatient and emergency visits, further surgery, and prolonged antibiotic treatment. 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). The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings. For instance, some studies involved all inpatient populations, whereas others focused on specific medical and/or surgical conditions (e.g., epilepsy in Mendizabal 2016, and surgical patients in Spector 2016).65,66 Given the evidence that the incidence of pressure ulcers increases with age,64 we performed a sensitivity analysis that excluded the pediatric study (Goudie 2015) and estimated the additional cost for hospital-acquired pressure ulcers among adult inpatients to be $12,712 ($278 to $25,145). Only two studies were explicit about the types of infection included in their definition of SSI. A surveillance system for maternal adverse events (not only for maternal mortality) would be helpful to understand the relationship between the adverse events and the associated outcome, including mortality and resource utilization. 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. Methods used to calculate cost and/or mortality. 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. Background: For example, we estimate for CLABSI that there are 0.15 excess deaths for each case. Bethesda, MD 20894, Copyright Cost of surgical site infections . We define additional cost as the incremental costs to the hospital for the inpatient stay attributable with the HAC of interest. Finally, few studies used clinical definitions of C. difficile infection and instead relied on ICD-9-based definitions, which may miss cases and may misclassify community-acquired cases as hospital-acquired. Furthermore, databases such as HCUP-NIS may have limitations to clearly identify cases (e.g., some researchers stated that they cannot distinguish a condition acquired prior to or during hospitalization). Accessibility 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. eCollection 2019 Oct. Rubin AE, Usta OB, Schloss R, Yarmush M, Golberg A. Adv Wound Care (New Rochelle). Surgical site infections are dangerous, costly, and preventable, and everyone in ambulatory surgery centers has a role in preventing them. CDI—the newest addition to the list of HAC—had the most robust body of literature with 9 studies for additional cost and 13 for excess mortality. The estimated costs of managing SSI differ widely, from less than dollar 400 per case for superficial SSI to more than dollar 30,000 per case for serious organ or space infections. Total number of live-births: 3,978,497 (2015 data). Conclusions: A prospective case-control study was undertaken at Korle-Bu Teaching Hospital, Ghana, to calculate the cost of surgical site infections (SSI). Estimates of relative risk for mortality varied and included two studies showing protective effects for ventilated patients with pneumonia compared to those without pneumonia.71,74 When these studies are excluded, the estimate for excess mortality increases to 26 percent of cases (meaning that for every 1,000 cases there are 260 excess deaths). Second, we estimated the incidence of maternal adverse events during delivery hospitalizations from four nationwide studies.59,60,61,62 The incidence rate ranged from 220 to 1,148 per 100,000 deliveries. The volume of literature, quality of studies, and relevance to our objectives varied for each of the HACs investigated. The need to treat SSIs places a severe financial strain on health care resources. Generalizability of patient population studied to U.S. populations. After further exclusions during data extraction based on the usability of study estimates in meta-analysis, we obtained our final list of articles included in meta-analysis for attributable cost and excess mortality associated with each HAC (Appendix C). Clipboard, Search History, and several other advanced features are temporarily unavailable. For example, the estimate of $5,746 for ADE means that for each ADE, on average, the hospital incurs an additional $5,746 in costs caring for that patient above and beyond the costs associated with an inpatient stay for the same patient without an ADE. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. For our mortality analysis, we were able to capture results from six studies collectively dealing with the three drug classes in the Common Formats for Surveillance definition of ADEs, including opioids, anticoagulants, and hypoglycemic agents. doi: 10.12659/MSM.927052. 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. The estimated costs of managing SSI differ widely, from less than $400 per case for superficial SSI to more than $30,000 per case for serious organ or space infections. Methods of the included studies ranged from analysis of national hospital discharge data to reviews of a single hospital’s CDI rates. Mortality studies used slightly different definitions of CLABSI. Variability in individual study estimates. *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. The sample size and standard error of individual study estimates ranged widely from 148 patients across 4 years39 to 670,767 patients across a 5-year study period.64 These differences were largely due to the source of data and the definition of population applied in each study and likely are the cause of the large confidence interval for our additional cost estimate (-$12,313 to $41,326). ( HAC ) Reduction Program costs and/or mortality for Hospital-Acquired Pressure ulcers study written by scholar and orthopedic surgeon a..., Petrosillo N, Hudson PM, Mitchell SA, Crosby C. J Hosp.... Including sources for each estimate, can be found in Appendix B. Exhibit 8 to non-infectious HACs 2014 ;! 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