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

doi:10.1016/j.jacc.2014.09.079

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 journal › Article › peer-review

56 Scopus citations

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 language	English (US)
Pages (from-to)	15-23
Number of pages	9
Journal	Journal of the American College of Cardiology
Volume	65
Issue number	1
DOIs	https://doi.org/10.1016/j.jacc.2014.09.079
State	Published - Jan 6 2015

Keywords

Health care-associated
costs length of stay
infection hospital

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jacc.2014.09.079

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Greco, G., Shi, W., Michler, R. E., Meltzer, D. O., Ailawadi, G., Hohmann, S. F., Thourani, V. H., Argenziano, M., Alexander, J. H., Sankovic, K., Gupta, L., Blackstone, E. H., Acker, M. A., Russo, M. J., Lee, A., Burks, S. G., Gelijns, A. C., Bagiella, E., Moskowitz, A. J., & Gardner, T. J. (2015). Costs associated with health care-associated infections in cardiac surgery. Journal of the American College of Cardiology, 65(1), 15-23. https://doi.org/10.1016/j.jacc.2014.09.079

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

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title = "Costs associated with health care-associated infections in cardiac surgery",

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).",

keywords = "Health care-associated, costs length of stay, infection hospital",

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

note = "Publisher Copyright: {\textcopyright} 2015 American College of Cardiology Foundation.",

year = "2015",

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doi = "10.1016/j.jacc.2014.09.079",

language = "English (US)",

volume = "65",

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T1 - Costs associated with health care-associated infections in cardiac surgery

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

AU - Burks, Sandra G.

AU - Gelijns, Annetine C.

AU - Bagiella, Emilia

AU - Moskowitz, Alan J.

AU - Gardner, Timothy J.

PY - 2015/1/6

Y1 - 2015/1/6

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).

AB - 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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Costs associated with health care-associated infections in cardiac surgery

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