Preventability of some hospital-acquired conditions questioned

CHICAGO — Hospital-acquired conditions that patients developed after surgical resection for cancer may be linked to preoperative comorbidities in some cases, and they may negatively affect provider payments dictated by CMS, researchers said at Digestive Disease Week 2014.

Investigator Daniela Molena, MD, director of thoracic surgery, Johns Hopkins Bayview Medical Center, Baltimore, and colleagues analyzed rates of hospital-acquired conditions (HAC) and how they related to a 2008 nonpayment policy instituted by CMS for such conditions. Of 11 HAC identified in 2013, the researchers questioned the preventability of HAC in their patient population, considering in some cases the conditions were associated with presurgical comorbidities, including steroid use, radiation, diabetes and weight loss.

“Our data … suggest that the nonpayment policy might be excessively penalizing health care providers since inherent patient factors are not modifiable and seem to play an important role in the development of HAC in this population,” the researchers wrote.

The study examined rates for the three most common HAC: surgical site infection (7.52%), urinary tract infection (2.93%) and deep vein thrombosis (2.3%) found in 74,381 patients (aged 18 years or older) who underwent surgical resection for cancer between 2005 and 2012. Patients were divided into HAC and non-HAC groups.

HAC patients were older, sicker and had a high BMI class, compared with non-HAC patients. At least one HAC occurred in 9,478 patients (12.74%). HAC patients also displayed greater 30-day mortality rates (3.65% vs. 2.18%), return to the operating room (12.34% vs. 4.61%), readmission rates at 30 days (25.88% vs. 9.36%) and longer lengths of stay (10 days vs. 6 days) (P<.001 for all).

Non-HAC patients were more likely to be discharged and sent home, while HAC patients were recommended for additional care elsewhere. HAC among patients decreased from 15% to 11% during the study.

“The development of the three most common hospital-acquired conditions in patients undergoing major resection for cancer are in large part related to intrinsic patient factors or particular surgery characteristics, and therefore the ability of the health care provider to reduce their incidence might be limited,” Molena said at the conference. “We think that the new payment policy might not really influence the quality improvement, but potentially limit the access to those patients at higher risk who need more health care programs.”

For more information:

Molena D. #232. Presented at: Digestive Disease Week 2014; May 3-6; Chicago.

Disclosure: The researchers report no relevant financial disclosures.