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Low-value procedures often harm patients

Use of low-value procedures was associated with more hospital-acquired complications, according to findings published in JAMA Internal Medicine.

“Studies of low-value care have focused on the prevalence of low-value care interventions but have rarely quantified downstream consequences of these interventions for patients or the health care system,” Tim Badgery-Parker, MBiostat, from the University of Sydney, and colleagues wrote.

Badgery-Parker and colleagues analyzed hospital admission data from 225 hospitals in Australia to determine the immediate harm linked to low-value procedures not expected to require admission.

The researchers assessed 9,330 episodes involving one of seven low-value procedures, including endoscopy for dyspepsia in patients younger than 55 years (3,689 episodes); knee arthroscopy for osteoarthritis or meniscal tears (3,963 episodes); colonoscopy for constipation in patients younger than 50 years (665 episodes); endovascular repair of abdominal aortic aneurysm in asymptomatic, high-risk patients (508 episodes); carotid endarterectomy in asymptomatic, high-risk patients (273 episodes); renal artery angioplasty (176 episodes); and spinal fusion for uncomplicated low-back pain (56 episodes).

They measured harm associated with low-value care based on 16 hospital-acquired complications, such as respiratory complications, renal failure, gastrointestinal bleeding and delirium. They also calculated the percentage of hospital-acquired complications for each low-value procedure and the difference in mean length of stay receiving a low-value procedure with and without any complications.

There were low rates of hospital-acquired complications for low-value endoscopy (4 [0.1%] episodes; 95% CI, 0.02-0.2), knee arthroscopy (18 [0.5%] episodes; 95% CI, 0.2-0.7), and colonoscopy (2 [0.3%] episodes; 95% CI, 0-0.9). However, rates of hospital-acquired complications were higher for low-value spinal fusion (4 [7.1%] episodes; 95% CI, 2.2-11.5), endovascular repair of abdominal aortic aneurysm (76 [15%] episodes; 95% CI, 11.1-19.7), carotid endarterectomy (21 [7.7%] episodes; 95% CI, 5.2-10.1), and renal artery angioplasty (15 [8.5%] episodes; 95% CI, 5.8-11.5).

Health care-associated infection was the most frequently observed hospital-acquired complication, accounting for 26.3% of all complications. Low-value renal artery angioplasty demonstrated the highest rate of health care-associated infection (8.4%; 95% CI, 5.2-11.4).

The median length of stay was doubled or more for patients with a hospital-acquired complication for any low-value procedure, compared with those without a complication.

“These findings suggest that use of these seven procedures in patients who probably should not receive them is harming some of those patients, consuming additional hospital resources, and potentially delaying care for other patients for whom the services would be appropriate,” Badgery-Parker and colleagues concluded. “Although only some immediate consequences of just seven low-value services were examined, harm related to all low-value procedures was noted, including high rates of harm for certain higher-risk procedures. The full burden of low-value care for patients and the health system is yet to be quantified.” – by Alaina Tedesco

Disclosures: Badgery-Parker reports receiving salary support from the Capital Markets Cooperative Research Centre–Health Market Quality Program and the University of Sydney, as well as consulting fees from Queensland Health and the Victorian Department of Health and Human Services. Please see study for all other authors’ relevant financial disclosures.