Sonali Shambhu MPH (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Researcher, Pfizer.) , Aliza S. Gordon MPH (is Director, Health Services Research, Elevance Health Public Policy Institute.) , Ying Liu PhD (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Manager, CORDS Oncology, Bristol Myers Squibb.), Maximilian Pany PhD (is Researcher, Elevance Health, Medicare Clinical Operations, and MD Candidate, Harvard Medical School.), William V. Padula PhD (is Assistant Professor, Department of Pharmaceutical and Health Economnics, Schaeffer Center, University of Southern California.), Peter J. Pronovost MD, PhD (is Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center.), Eugene Hsu MD, MBA (is Chief Medical Officer and Regional Vice President, Elevance Health, Medicare Clinical Operations, and Adjunct Faculty, Stanford University School of Medicine. Please address correspondence to Aliza S. Gordon)
{"title":"与特定手术部位感染相关的医疗使用、成本和死亡率负担。","authors":"Sonali Shambhu MPH (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Researcher, Pfizer.) , Aliza S. Gordon MPH (is Director, Health Services Research, Elevance Health Public Policy Institute.) , Ying Liu PhD (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Manager, CORDS Oncology, Bristol Myers Squibb.), Maximilian Pany PhD (is Researcher, Elevance Health, Medicare Clinical Operations, and MD Candidate, Harvard Medical School.), William V. Padula PhD (is Assistant Professor, Department of Pharmaceutical and Health Economnics, Schaeffer Center, University of Southern California.), Peter J. Pronovost MD, PhD (is Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center.), Eugene Hsu MD, MBA (is Chief Medical Officer and Regional Vice President, Elevance Health, Medicare Clinical Operations, and Adjunct Faculty, Stanford University School of Medicine. Please address correspondence to Aliza S. Gordon)","doi":"10.1016/j.jcjq.2024.08.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To assess the additional health care utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study used commercial and Medicare Advantage/Supplement claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year postdischarge.</div></div><div><h3>Results</h3><div>The total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days, all <em>p</em> < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.83 to 25.07, all <em>p</em> ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio 1.56, <em>p</em> = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI cohorts vs. matched comparison cohorts for the index episode and 6 months and 1 year postdischarge. Average adjusted 1-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (<em>p</em> < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Patients with SSIs experienced higher LOS, readmission rates, and total medical costs, and higher mortality for some populations, compared to their matched comparison cohorts during the first year postdischarge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"50 12","pages":"Pages 857-866"},"PeriodicalIF":2.3000,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections\",\"authors\":\"Sonali Shambhu MPH (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Researcher, Pfizer.) , Aliza S. Gordon MPH (is Director, Health Services Research, Elevance Health Public Policy Institute.) , Ying Liu PhD (formerly Senior Researcher, Elevance Health Public Policy Institute, is Senior Manager, CORDS Oncology, Bristol Myers Squibb.), Maximilian Pany PhD (is Researcher, Elevance Health, Medicare Clinical Operations, and MD Candidate, Harvard Medical School.), William V. Padula PhD (is Assistant Professor, Department of Pharmaceutical and Health Economnics, Schaeffer Center, University of Southern California.), Peter J. Pronovost MD, PhD (is Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center.), Eugene Hsu MD, MBA (is Chief Medical Officer and Regional Vice President, Elevance Health, Medicare Clinical Operations, and Adjunct Faculty, Stanford University School of Medicine. Please address correspondence to Aliza S. Gordon)\",\"doi\":\"10.1016/j.jcjq.2024.08.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To assess the additional health care utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study used commercial and Medicare Advantage/Supplement claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year postdischarge.</div></div><div><h3>Results</h3><div>The total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days, all <em>p</em> < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.83 to 25.07, all <em>p</em> ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio 1.56, <em>p</em> = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI cohorts vs. matched comparison cohorts for the index episode and 6 months and 1 year postdischarge. Average adjusted 1-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (<em>p</em> < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Patients with SSIs experienced higher LOS, readmission rates, and total medical costs, and higher mortality for some populations, compared to their matched comparison cohorts during the first year postdischarge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.</div></div>\",\"PeriodicalId\":14835,\"journal\":{\"name\":\"Joint Commission journal on quality and patient safety\",\"volume\":\"50 12\",\"pages\":\"Pages 857-866\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-08-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Joint Commission journal on quality and patient safety\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1553725024002599\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024002599","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
The Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections
Objective
To assess the additional health care utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures.
Methods
This retrospective observational cohort study used commercial and Medicare Advantage/Supplement claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year postdischarge.
Results
The total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days, all p < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.83 to 25.07, all p ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio 1.56, p = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI cohorts vs. matched comparison cohorts for the index episode and 6 months and 1 year postdischarge. Average adjusted 1-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (p < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (p < 0.05).
Conclusion
Patients with SSIs experienced higher LOS, readmission rates, and total medical costs, and higher mortality for some populations, compared to their matched comparison cohorts during the first year postdischarge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.
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