Cargando…

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

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. METHODS: Retrospective cohort study of hip, knee, and spine surgeries at an academic hospital in...

Descripción completa

Detalles Bibliográficos
Autores principales: Rampersaud, Y. Raja, Sundararajan, Kala, Docter, Shgufta, Perruccio, Anthony V., Gandhi, Rajiv, Adams, Diana, Briggs, Natasha, Davey, J. Rod, Fehlings, Michael, Lewis, Stephen J., Magtoto, Rosalie, Massicotte, Eric, Sarro, Angela, Syed, Khalid, Mahomed, Nizar N., Veillette, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10598977/
https://www.ncbi.nlm.nih.gov/pubmed/37880706
http://dx.doi.org/10.1186/s12913-023-10055-z
_version_ 1785125675429003264
author Rampersaud, Y. Raja
Sundararajan, Kala
Docter, Shgufta
Perruccio, Anthony V.
Gandhi, Rajiv
Adams, Diana
Briggs, Natasha
Davey, J. Rod
Fehlings, Michael
Lewis, Stephen J.
Magtoto, Rosalie
Massicotte, Eric
Sarro, Angela
Syed, Khalid
Mahomed, Nizar N.
Veillette, Christian
author_facet Rampersaud, Y. Raja
Sundararajan, Kala
Docter, Shgufta
Perruccio, Anthony V.
Gandhi, Rajiv
Adams, Diana
Briggs, Natasha
Davey, J. Rod
Fehlings, Michael
Lewis, Stephen J.
Magtoto, Rosalie
Massicotte, Eric
Sarro, Angela
Syed, Khalid
Mahomed, Nizar N.
Veillette, Christian
author_sort Rampersaud, Y. Raja
collection PubMed
description 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. 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. 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. 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-10055-z.
format Online
Article
Text
id pubmed-10598977
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-105989772023-10-26 Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study Rampersaud, Y. Raja Sundararajan, Kala Docter, Shgufta Perruccio, Anthony V. Gandhi, Rajiv Adams, Diana Briggs, Natasha Davey, J. Rod Fehlings, Michael Lewis, Stephen J. Magtoto, Rosalie Massicotte, Eric Sarro, Angela Syed, Khalid Mahomed, Nizar N. Veillette, Christian BMC Health Serv Res Research 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. 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. 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. 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-10055-z. BioMed Central 2023-10-25 /pmc/articles/PMC10598977/ /pubmed/37880706 http://dx.doi.org/10.1186/s12913-023-10055-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Rampersaud, Y. Raja
Sundararajan, Kala
Docter, Shgufta
Perruccio, Anthony V.
Gandhi, Rajiv
Adams, Diana
Briggs, Natasha
Davey, J. Rod
Fehlings, Michael
Lewis, Stephen J.
Magtoto, Rosalie
Massicotte, Eric
Sarro, Angela
Syed, Khalid
Mahomed, Nizar N.
Veillette, Christian
Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study
title Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study
title_full Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study
title_fullStr Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study
title_full_unstemmed Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study
title_short Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study
title_sort hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10598977/
https://www.ncbi.nlm.nih.gov/pubmed/37880706
http://dx.doi.org/10.1186/s12913-023-10055-z
work_keys_str_mv AT rampersaudyraja hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT sundararajankala hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT doctershgufta hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT perruccioanthonyv hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT gandhirajiv hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT adamsdiana hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT briggsnatasha hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT daveyjrod hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT fehlingsmichael hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT lewisstephenj hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT magtotorosalie hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT massicotteeric hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT sarroangela hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT syedkhalid hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT mahomednizarn hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy
AT veillettechristian hospitalspendingandlengthofstayattributabletoperioperativeadverseeventsforinpatienthipkneeandspinesurgeryaretrospectivecohortstudy