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J Am Coll Cardiol. 2015 Jan 6;65(1):15-23. doi: 10.1016/j.jacc.2014.09.079.

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

Author information

1
International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York. Electronic address: giampaolo.greco@mountsinai.org.
2
International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
3
Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
4
Department of Medicine, University of Chicago, Chicago, Illinois.
5
Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
6
University HealthSystem Consortium, Chicago, Illinois.
7
Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
8
Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
9
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
10
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
11
Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
12
Barnabas Heart Hospital, Newark, New Jersey.
13
Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland.
14
Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware.

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 infection; hospital costs; length of stay

PMID:
25572505
PMCID:
PMC4293042
DOI:
10.1016/j.jacc.2014.09.079
[Indexed for MEDLINE]
Free PMC Article

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