Three studies were regionally specific and involved single hospitals, one of which included all surgical patients that met the HAC definition.42,67,68 The three remaining studies used national claims databases but focused on specialized surgical populations.41,69,70, Studies for both cost and mortality estimation had a wide range of individual estimates. To estimate excess mortality, we combined the results of meta-analysis with estimates of underlying mortality in the population as shown in Exhibit 8. Adverse impact of surgical site infections in English hospitals. 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. Privacy, Help Unable to load your collection due to an error, Unable to load your delegates due to an error. Background: Surgical site infections (SSIs) are associated with increased morbidity and mortality. for ive different infection sites will be developed, including surgical site infections (SSIs), central line associated bloodstream infections (CLABSIs), ventilator-associated pneumonias (VAPs), catheter-associated urinary-tract infections (CAUTIs), and 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. There was significant variability in reported mortality between studies, due mainly to variation in patient population and data source. Indirect costs include post-care costs like lost wages, loss of functional capacity, and loss of mental health. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. doi: 10.12659/MSM.927052. Objective: To determine the attributable costs associated with surgical site infection (SSI) following breast surgery. The 95% CI arises from a two-sided test of the hypothesis that the estimate of additional costs does not differ from a value of zero dollars. 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. Would you like email updates of new search results? 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. 1-4 Treatment of SSIs often includes long courses of antibiotics, months of physical therapy, readmissions to the hospital, and reoperations. 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. Surgical site infections (SSIs) acquired by patients in hospitals are associated with costs nearly twice as high compared to patients who do not have this complication. 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. 1 Despite increased implementation of quality improvement initiatives, SSIs continue to be an ongoing problem. 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. 2014 Jun;149(6):575-81. doi: 10.1001/jamasurg.2013.4663. The studies varied by sample size (116,000 to 49 million), study period (1991 through 2011), study duration (3 years to 11 years), and data sources (one used National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, one used National Hospital Discharge Survey, and two used HCUP data). Methods of the included studies ranged from analysis of national hospital discharge data to reviews of a single hospital’s CDI rates. National Library of Medicine Percentage of pregnancy-related deaths due to adverse events: 37.1 percent (2011-2013 data). Since we were not able to identify studies providing estimates of mortality due to OBAE, we used an alternative method to directly estimate the excess mortality using data on incidence of maternal adverse events and the risk of death among women experiencing maternal adverse events. the third section, the annual national cost estimates . Background: Although surgical site infections (SSIs) are known to be associated with increased length of stay (LOS) and additional cost, their impact on the profitability of surgical procedures is unknown. 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. Proportion of overall maternal deaths related to pregnancy: 38.2 percent (2011-2013 data). 2002;3 Suppl 1:S37-43. When a patient develops an infection after surgery, the cost of care increases 119 percent, on average, at a teaching hospital, and 101 percent at a community hospital. 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. Internet Citation: Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. 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. Epub 2019 Apr 3. A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. 8600 Rockville Pike Instead of reporting on mortality associated with maternal adverse events, most studies analyzed maternal adverse events as the end point. FOIA All of the later studies’ estimates fall between $40,000 and $80,000. 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). Preoperative Intranasal Decolonization with Topical Povidone-Iodine Antiseptic and the Incidence of Surgical Site Infection: A Review. The United States has an estimated 2.1 million nosocomial infections per year with postoperative surgical site infections (SSIs) being the third most common. Careers. The most recent estimate comes from 2009, and two others date from prior to 2000.71,72,73 The two studies prior to 2000 reported the lowest attributable costs at $19,000 and $33,000. 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. For instance, some studies evaluated all inpatient populations, yet others focused on specific medical and/or surgical conditions (e.g., epilepsy in Mendizabal 2016; cirrhosis as denominator condition for Ali 2011; patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm for Hennesey 2012).65,82,83. Surg Infect (Larchmt). 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. Attributable cost and extra length of stay of surgical site infection at a Ghanaian teaching hospital Infection Prevention in Practice, Vol. Excess mortality is calculated as the difference between the probability of death among those who have the HAC and the probability of death among those who do not have the HAC but are at risk. Full text review eliminated 740 of the remaining 941 articles (78.6 percent). 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). Estimated costs vary from $3.5 to $10 billion in the US. 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. 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). Methods: Review of current practice and guidelines.. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. 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. Methods: 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). Methods used to calculate cost and/or mortality. 2017 May;96(1):1-15. doi: 10.1016/j.jhin.2017.03.004. 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