Hospital-acquired infections after cardiac surgery linked to cost, length of stay, readmission

Hospital cost, length of stay and readmissions were strongly associated with hospital-acquired infections following cardiac surgery, according to data from a new study.

Researchers investigated the cost associated with major types of hospital-acquired infections within 2 months after cardiac surgery.

They prospectively collected data from an observational study in which patients (n=4,320; mean age, 64 years; 66% men) were monitored for infection for 65 days after cardiac surgery, and merged that data with routinely collected financial data.

Giampaolo Greco, PhD, MPH, and colleagues then estimated the incremental length of stay and cost associated with hospital-acquired infections, after adjusting for patient demographics, clinical history, baseline laboratory values and the type of surgery performed.

Greco, from the International Center for Health Outcomes and Innovation Research of the department of health science and policy at the Icahn School of Medicine, Mount Sinai Medical Center, and colleagues found that 2.8% of patients experienced a major hospital-acquired infection during index hospitalization. The most common major infections were pneumonia (48%), sepsis (20%) and Clostridium difficile colitis (18%).

The estimated annual cost associated with an infection was $38,000, with 47% of that amount related to ICU services, according to the researchers.

They found that on average, the length of stay of patients who had a major hospital-acquired infection was 14 days longer than those who did not.

They also found that of the 849 readmissions in the study population, 8.7% were related to major hospital-acquired infections. The cost of readmissions due to infection was approximately threefold higher than the cost of readmissions due to other reasons, according to the researchers.

The findings support “the widely held belief that reducing the enormous infection-related tolls of mortality and morbidity is not only a clinical imperative, but, especially in the current economic environment, a major economic necessity,” Greco and colleagues wrote.

In a related editorial, Vinay Badhwar, MD, and Jeffrey P. Jacobs, MD, wrote that the results may be skewed by the inclusion of patients requiring transplantation or a ventricular assist device, who are “known to be at exceedingly high risk for infection and readmission.”

“Before recommendations are made about how the development of infections following cardiac surgery might be addressed in health care policy and hospital-level reimbursement, further procedure-specific granularity is required,” Badhwar, from the division of cardiac surgery at Presbyterian University Hospital, University of Pittsburgh; and Jacobs, from the Johns Hopkins University All Children’s Hospital, St. Petersburg, Fla., wrote.

For more information:

Badhwar V. J Am Coll Cardiol. 2015;65:24-26.

Greco G. J Am Coll Cardiol. 2015;65:15-23.

Disclosure: See the full study for a list of relevant financial disclosures. Badhwar and Jacobs report no relevant disclosures.