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Surgery. 2015 Jul;158(1):96-103. doi: 10.1016/j.surg.2015.02.015. Epub 2015 Apr 18.

Beyond incidence: Costs of complications in trauma and what it means for those who pay.

Author information

1
Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham & Women's Hospital, Boston, MA; Department of Surgery, Brigham & Women's Hospital, Boston, MA. Electronic address: ahhaider@partners.org.
2
The Massachusetts Institute of Technology Sloan School of Management, Cambridge, MA.
3
Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham & Women's Hospital, Boston, MA; Department of Surgery, Brigham & Women's Hospital, Boston, MA.
4
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
5
Department of Surgery, Howard University College of Medicine, Washington, DC.
6
Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, MD.
7
Department of Health Policy & Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Abstract

INTRODUCTION:

Trauma patients have greater rates of complications than general surgery patients; however, existing surgical pay-for-performance (P4P) guidelines have yet to be adapted for trauma care. To better understand whether current P4P measures are applicable to trauma, this study used nationally representative data to determine the mortality and attributable costs associated with the presence or absence of both Centers for Medicare and Medicaid Services-recognized complications (urinary tract infections, surgical site infections [SSIs], and pneumonia) and other major trauma-related complications.

METHODS:

Trauma admissions were extracted from the 2008 National Inpatient Sample using primary ICD-9-CM diagnosis codes (range, 800-905, 910-939, 950-958). Patients aged 18-65 years with a duration of hospital stay of >3 days and isolated complications were included. To account for differences in patient factors, coarsened-exact matching was used to create comparable cohorts of adult patients with and without complications. Multivariable regression was then performed within matched groups to determine differences in cost and mortality, controlling for hospital characteristics and wage index.

RESULTS:

Of 493,372 trauma patients, 78,156 met inclusion criteria, of whom 24.4% had an isolated complication. Consistent with surgical P4P guidelines, SSI, urinary tract infections, and pneumonia had the greatest incidence (8.0%, 5.2%, and 4.4%, respectively); however, mortality in matched patients with complications was greatest for sepsis (odds ratio [OR], 9.76; 95% CI, 3.84-24.80), myocardial infarction (MI; OR, 4.21; 95% CI, 1.70-10.44) and stroke (OR, 3.02; 95% CI, 1.40-6.52). Excess costs associated with a complication were similarly greatest for sepsis (relative cost, 1.84; 95% CI, 1.57-2.17), followed by acute respiratory distress syndrome (ARDS; relative cost, 1.84; 95% CI, 1.7-1.99) and MI (relative cost, 1.73; 95% CI, 1.51-1.99).

CONCLUSION:

Consideration of attributable costs and mortality suggest that additional complications have a substantial impact among trauma patients, beyond the conditions used in general surgery P4P guidelines. These aspects of trauma should be prioritized to capture the influence of complications in trauma that the incidence of frequent but less costly conditions overlooks.

PMID:
25900034
DOI:
10.1016/j.surg.2015.02.015
[Indexed for MEDLINE]

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