Costs associated with health care-associated infections in cardiac surgery

Giampaolo Greco, Wei Shi, Robert E. Michler, David O. Meltzer, Gorav Ailawadi, Samuel F. Hohmann, Vinod H. Thourani, Michael Argenziano, John H. Alexander, Kathy Sankovic, Lopa Gupta, Eugene H. Blackstone, Michael A. Acker, Mark J. Russo, Albert Lee, Sandra G. Burks, Annetine C. Gelijns, Emilia Bagiella, Alan J. Moskowitz, Timothy J. Gardner

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited.

Objectives This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery.

Methods Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type.

Results Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs.

Conclusions Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).

Original languageEnglish (US)
Pages (from-to)15-23
Number of pages9
JournalJournal of the American College of Cardiology
Volume65
Issue number1
DOIs
StatePublished - Jan 6 2015

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Cross Infection
Thoracic Surgery
Costs and Cost Analysis
Length of Stay
Clostridium difficile
Hospital Costs
Practice Management
Risk Management
Colitis
Infection
Ambulatory Surgical Procedures
Multicenter Studies
Observational Studies
Intensive Care Units
Linear Models
Sepsis
Pneumonia
Hospitalization
Economics
Demography

Keywords

  • costs length of stay
  • Health care-associated
  • infection hospital

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Costs associated with health care-associated infections in cardiac surgery. / Greco, Giampaolo; Shi, Wei; Michler, Robert E.; Meltzer, David O.; Ailawadi, Gorav; Hohmann, Samuel F.; Thourani, Vinod H.; Argenziano, Michael; Alexander, John H.; Sankovic, Kathy; Gupta, Lopa; Blackstone, Eugene H.; Acker, Michael A.; Russo, Mark J.; Lee, Albert; Burks, Sandra G.; Gelijns, Annetine C.; Bagiella, Emilia; Moskowitz, Alan J.; Gardner, Timothy J.

In: Journal of the American College of Cardiology, Vol. 65, No. 1, 06.01.2015, p. 15-23.

Research output: Contribution to journalArticle

Greco, G, Shi, W, Michler, RE, Meltzer, DO, Ailawadi, G, Hohmann, SF, Thourani, VH, Argenziano, M, Alexander, JH, Sankovic, K, Gupta, L, Blackstone, EH, Acker, MA, Russo, MJ, Lee, A, Burks, SG, Gelijns, AC, Bagiella, E, Moskowitz, AJ & Gardner, TJ 2015, 'Costs associated with health care-associated infections in cardiac surgery', Journal of the American College of Cardiology, vol. 65, no. 1, pp. 15-23. https://doi.org/10.1016/j.jacc.2014.09.079
Greco, Giampaolo ; Shi, Wei ; Michler, Robert E. ; Meltzer, David O. ; Ailawadi, Gorav ; Hohmann, Samuel F. ; Thourani, Vinod H. ; Argenziano, Michael ; Alexander, John H. ; Sankovic, Kathy ; Gupta, Lopa ; Blackstone, Eugene H. ; Acker, Michael A. ; Russo, Mark J. ; Lee, Albert ; Burks, Sandra G. ; Gelijns, Annetine C. ; Bagiella, Emilia ; Moskowitz, Alan J. ; Gardner, Timothy J. / Costs associated with health care-associated infections in cardiac surgery. In: Journal of the American College of Cardiology. 2015 ; Vol. 65, No. 1. pp. 15-23.
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abstract = "Background Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited.Objectives This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery.Methods Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type.Results Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8{\%}) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48{\%}), sepsis (20{\%}), and Clostridium difficile colitis (18{\%}). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47{\%} was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7{\%} were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs.Conclusions Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).",
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AU - Greco, Giampaolo

AU - Shi, Wei

AU - Michler, Robert E.

AU - Meltzer, David O.

AU - Ailawadi, Gorav

AU - Hohmann, Samuel F.

AU - Thourani, Vinod H.

AU - Argenziano, Michael

AU - Alexander, John H.

AU - Sankovic, Kathy

AU - Gupta, Lopa

AU - Blackstone, Eugene H.

AU - Acker, Michael A.

AU - Russo, Mark J.

AU - Lee, Albert

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AU - Gelijns, Annetine C.

AU - Bagiella, Emilia

AU - Moskowitz, Alan J.

AU - Gardner, Timothy J.

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N2 - Background Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited.Objectives This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery.Methods Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type.Results Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs.Conclusions Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).

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