Moghadamyeghaneh Z, Stamos MJ, Stewart L, et al.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimen.... Date of publication 2018 Sep 17;volume ():.
1. J Gastrointest Surg. 2018 Sep 17. doi: 10.1007/s11605-018-3957-9. [Epub ahead of
print]
Patient Co-Morbidity and Functional Status Influence the Occurrence of Hospital
Acquired Conditions More Strongly than Hospital Factors.
Moghadamyeghaneh Z(1), Stamos MJ(2), Stewart L(3)(4).
Author information:
(1)Department of Surgery, University of California, San Francisco, CA, USA.
(2)Department of Surgery, University of California, Irvine, USA.
(3)Department of Surgery, University of California, San Francisco, CA, USA.
lygia.stewart@va.gov.
(4)Department of Surgery, San Francisco VA Medical Center, Surgery (112) 4150
Clement Street, San Francisco, CA, 94121, USA. lygia.stewart@va.gov.
BACKGROUND: Never events (NE) and hospital-acquired conditions (HAC) are used by
Medicare/Medicaid Services to define hospital performance measures that dictate
payments/penalties. Pre-op patient comorbidity may significantly influence HAC
development.
METHODS: We studied 8,118,615 patients from the NIS database (2002-2012) who
underwent upper/lower gastrointestinal and/or hepatopancreatobiliary procedures.
Multivariate analysis, using logistic regression, was used to identify HAC and NE
risk factors.
RESULTS: A total of 63,762 (0.8%) HAC events and 1645 (0.02%) NE were reported. A
total of 99.9% of NE were retained foreign body. Most frequent HAC were: pressure
ulcer stage III/IV (36.7%), poor glycemic control (26.9%), vascular
catheter-associated infection (20.3%), and catheter-associated urinary tract
infection (13.7%). Factors correlating with HAC included: open surgical approach
(AOR: 1.25, P < 0.01), high-risk patients with significant comorbidity [severe
loss function pre-op (AOR: 6.65, P < 0.01), diabetes with complications (AOR:
2.40, P < 0.01), paraplegia (AOR: 3.14, P < 0.01), metastatic cancer (AOR: 1.30,
P < 0.01), age > 70 (AOR: 1.09, P < 0.01)], hospital factors [small vs. large
(AOR: 1.07, P < 0.01), non-teaching vs teaching (AOR: 1.10, P < 0.01), private
profit vs. non-profit/governmental (AOR: 1.20, P < 0.01)], severe preoperative
mortality risk (AOR: 3.48, P < 0.01), and non-elective admission (AOR: 1.38,
P < 0.01). HAC were associated with increased: hospitalization length (21 vs
7 days, P < 0.01), hospital charges ($164,803 vs $54,858, P < 0.01), and
mortality (8 vs 3%, AOR: 1.14, P < 0.01).
CONCLUSION: HAC incidence was highest among patients with severe comorbid
conditions. While small, non-teaching, and for-profit hospitals had increased
HAC, the strongest HAC risks were non-modifiable patient factors (preoperative
loss function, diabetes, paraplegia, advanced age, etc.). This data questions the
validity of using HAC as hospital performance measures, since hospitals caring
for these complex patients would be unduly penalized. CMS should consider patient
comorbidity as a crucial factor influencing HAC development.
DOI: 10.1007/s11605-018-3957-9
PMID: 30225796
