Presentation Abstract

Session: APS.213.01-Risk Prediction, Appropriateness and Health Economics: Quality of Care and Outcomes
Presentation: 18267 - The Economic Impact of Healthcare Associated Infections in Cardiac Surgery
Pres Time: Sunday, Nov 17, 2013, 9:30 AM -11:00 AM
Location: Hall F, Core 2, Poster Board: 2133
Pres. Time: Sunday, Nov 17, 2013, 9:30 AM -11:00 AM
Specialty: +213. Quality of Care, Outcomes Research and Health Policy
Keywords: Cardiac surgery; Health policy; Health economics; Patient safety; Quality of medical care
Authors: Giampaolo Greco, Wei Shi, Icahn Sch of Med at Mount Sinai, New York, NY; Robert Michler, Montefiore-Einstein Heart Ctr, Bronx, NY; Eugene Blackstone, Cleveland Clinic, Cleveland, OH; Irving L Kron, Univ of Virginia Health System, Charlottesville, VA; Ellen Moquete, Icahn Sch of Med at Mount Sinai, New York, NY; Joseph Y Woo, Univ of Pennsylvania, Philadelphia, PA; Alan J Moskowitz, Icahn Sch of Med at Mount Sinai, New York, NY; Vinod Thourani, Emory Univ Hosp Midtown, Atlanta, GA; A. Marc Gillinov, Cleveland Clinic, Cleveland, OH; Annetine C Gelijns, Icahn Sch of Med at Mount Sinai, New York, NY; Michael Argenziano, Columbia Univ Medical Ctr, New York, NY; John H Alexander, Duke Clinical Res Inst, Durham, NC; Louis P Perrault, Montreal Heart Inst, Montreal,, QC, Canada; Albert Lee, NHLBI, Bethesda, MD; Sandra G Burks, Univ of Virginia, Charlottesville, VA; Patrick T O'Gara, Brigham and Women’s Hosp, Boston, MA; Emilia Bagiella, Icahn Sch of Med at Mount Sinai, New York, NY; Samuel F Hohmann, Univ Health Consortium, Chicago, IL; Timothy J Gardner, Christiana Care Health System, Newark, DE
Abstract: BACKGROUND Healthcare-associated infections (HAIs) are the most common non-cardiac complication after cardiac surgery, and are associated with increased morbidity, mortality and resource use. Despite being the focus of quality improvement efforts, there is little information about their economic impact. This prospective cohort study examines the incremental costs associated with HAIs within 65 days of cardiac surgery.
METHODS Clinical data on major and minor infections (CDC/NHSN definitions) from 9 academic centers were merged with related financial data routinely collected by the University Health Consortium. Incremental length of stay (LOS) and cost attributable to HAIs were estimated using generalized linear models, adjusting for patient demographics, clinical history, baseline labs and surgery type.
RESULTS The most common procedures in 4313 cardiac surgery patients were isolated valve (31%), isolated CABG (29%), and CABG/valve (12%), with a mean age 64±13 years. During the index hospitalization, 3% of patients experienced major infections, including pneumonia, sepsis, C. Difficile and surgical site infections. The most common minor infection was UTI, which occurred in 2% of patients. The adjusted average incremental cost due to major infection was nearly $50,000 (table), with the additional ICU stay increasing the index hospitalization cost by $1094/day during the first 2 weeks after surgery. Patients with major index HAIs were nearly twice as likely to be readmitted as those without. Overall, there were 855 readmissions; 19 % due to HAIs, costing on average nearly twice as much as non-HAI related readmissions.
CONCLUSIONS In an era that emphasizes early discharge and the need to avert preventable readmissions, this study shows that both are heavily influenced by infection rates and that the costs of HAIs in cardiac surgery are substantial. These data provide critical insights about the potential economic impact of infection prevention programs.

Disclosures:  G. Greco, None; W. Shi, None; R. Michler, None; E. Blackstone, None; I.L. Kron, None; E. Moquete, None; J.Y. Woo, None; A.J. Moskowitz, None; V. Thourani, None; A. Gillinov, None; A.C. Gelijns, None; M. Argenziano, None; J.H. Alexander, Phyxius, Modest,Research Grant; Moerae Matrix, Modest,Consultant/Advisory Board; CSL Behring, Modest,Consultant/Advisory Board; Sohmalution, Modest,Consultant/Advisory Board; Bayer, Modest,Consultant/Advisory Board; Boehringer Ingelheim, Modest,Consultant/Advisory Board; Janssen Pharmaceuticals, Modest,Consultant/Advisory Board; Novartis, Modest,Consultant/Advisory Board; Orexigen, Modest,Consultant/Advisory Board; Xoma Pharmaceuticals, Modest,Consultant/Advisory Board; Bristol Myers Squibb, Significant,Research Grant; CSL Behring, Significant,Research Grant; National Institutes of Health, Significant,Research Grant; Regado Biosciences, Significant,Research Grant; Pfizer, Significant,Research Grant; Bristol Myers Squibb, Significant,Consultant/Advisory Board; Pfizer, Significant,Consultant/Advisory Board; Daiichai Sankyo, Significant,Consultant/Advisory Board; L.P. Perrault, None; A. Lee, None; S.G. Burks, None; P.T. O'Gara, None; E. Bagiella, None; S.F. Hohmann, None; T.J. Gardner, Chair, Steering Committee, Cardiothoracic Surgical Trials Network, NHLBI, Modest,Other.



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