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Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study.

Authors :
Rampersaud YR
Sundararajan K
Docter S
Perruccio AV
Gandhi R
Adams D
Briggs N
Davey JR
Fehlings M
Lewis SJ
Magtoto R
Massicotte E
Sarro A
Syed K
Mahomed NN
Veillette C
Source :
BMC health services research [BMC Health Serv Res] 2023 Oct 25; Vol. 23 (1), pp. 1150. Date of Electronic Publication: 2023 Oct 25.
Publication Year :
2023

Abstract

Background: The incremental hospital cost and length of stay (LOS) associated with adverse events (AEs) has not been well characterized for planned and unplanned inpatient spine, hip, and knee surgeries.<br />Methods: Retrospective cohort study of hip, knee, and spine surgeries at an academic hospital in 2011-2012. Adverse events were prospectively collected for 3,063 inpatient cases using the Orthopaedic Surgical AdVerse Event Severity (OrthoSAVES) reporting tool. Case costs were retrospectively obtained and inflated to equivalent 2021 CAD values. Propensity score methodology was used to assess the cost and LOS attributable to AEs, controlling for a variety of patient and procedure factors.<br />Results: The sample was 55% female and average age was 64; 79% of admissions were planned. 30% of cases had one or more AEs (82% had low-severity AEs at worst). The incremental cost and LOS attributable to AEs were $8,500 (95% confidence interval [CI]: 5100-11,800) and 4.7 days (95% CI: 3.4-5.9) per admission. This corresponded to a cumulative $7.8 M (14% of total cohort cost) and 4,290 bed-days (19% of cohort bed-days) attributable to AEs. Incremental estimates varied substantially by (1) admission type (planned: $4,700/2.4 days; unplanned: $20,700/11.5 days), (2) AE severity (low: $4,000/3.1 days; high: $29,500/11.9 days), and (3) anatomical region (spine: $19,800/9 days; hip: $4,900/3.8 days; knee: $1,900/1.5 days). Despite only 21% of admissions being unplanned, adverse events in these admissions cumulatively accounted for 59% of costs and 62% of bed-days attributable to AEs.<br />Conclusions: This study comprehensively demonstrates the considerable cost and LOS attributable to AEs in orthopaedic and spine admissions. In particular, the incremental cost and LOS attributable to AEs per admission were almost five times as high among unplanned admissions compared to planned admissions. Mitigation strategies focused on unplanned surgeries may result in significant quality improvement and cost savings in the healthcare system.<br /> (© 2023. BioMed Central Ltd., part of Springer Nature.)

Details

Language :
English
ISSN :
1472-6963
Volume :
23
Issue :
1
Database :
MEDLINE
Journal :
BMC health services research
Publication Type :
Academic Journal
Accession number :
37880706
Full Text :
https://doi.org/10.1186/s12913-023-10055-z