Is the Centers for Medicare and Medicaid Service's lack of reimbursement for postoperative urinary tract infections in elderly emergency surgery patients justified?

Martin D. Zielinski, Kristine M. Thomsen, Stephanie F. Polites, Mohammad A. Khasawneh, Donald H. Jenkins, Elizabeth B Habermann

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Urinary tract infections, a risk factor for readmission, have been deemed a potentially preventable problem and, therefore, not reimbursable by the Centers for Medicare and Medicaid Services since 2008. Defining the risk factors for development of urinary tract infection in the postoperative period will provide risk stratification for development of urinary tract infection in these challenging patients. Pre-, intra-, and postoperative characteristics were collected for patients ≥65 years who underwent an emergency abdominal operation from the 2005 to 2012 National Surgical Quality Improvement Program Participant User File, a database of 374 participating hospitals. In-hospital urinary tract infections occurring within 30 days of the operation were identified. Multivariable logistic regression analysis was conducted to identify risk factors of urinary tract infection. In total, 53,879 patients were included, 1,881 (3.5%) of whom were diagnosed with a postoperative urinary tract infection before discharge. In-hospital urinary tract infection was associated with a longer hospital stay (27 vs 13 days, P < .001) and greater 30-day mortality rates (18% vs 16%, P = .003). The rate of urinary tract infection decreased from 4.5% before the Centers for Medicare and Medicaid Services decree to 3.2% thereafter (P < .001). Multivariable logistic regression demonstrated advanced age, female sex, insulin-dependent diabetes mellitus, dependent functional status, open wound, hypoalbuminemia, increased American Society of Anesthesiologists class, operative approach, and prolonged operative time were independent risk factors for development of postoperative urinary tract infection. Although postoperative rates of urinary tract infection decreased after the Centers for Medicare and Medicaid Services decree, the lack of reimbursement is not justified, as few modifiable risk factors to further improve postoperative urinary tract infection rates in elderly emergency surgical patients were identified. Although targeted interventions may be developed, this complication is not easily preventable and will continue to plague acute care surgeons taking care of this challenging patient population.

Original languageEnglish (US)
Pages (from-to)1009-1015
Number of pages7
JournalSurgery
Volume156
Issue number4
StatePublished - 2014

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Centers for Medicare and Medicaid Services (U.S.)
Urinary Tract Infections
Emergencies
Cross Infection
Logistic Models
Hypoalbuminemia
Plague
Operative Time
Quality Improvement
Type 1 Diabetes Mellitus
Postoperative Period
Length of Stay
Patient Care
Regression Analysis
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Is the Centers for Medicare and Medicaid Service's lack of reimbursement for postoperative urinary tract infections in elderly emergency surgery patients justified? / Zielinski, Martin D.; Thomsen, Kristine M.; Polites, Stephanie F.; Khasawneh, Mohammad A.; Jenkins, Donald H.; Habermann, Elizabeth B.

In: Surgery, Vol. 156, No. 4, 2014, p. 1009-1015.

Research output: Contribution to journalArticle

Zielinski, Martin D. ; Thomsen, Kristine M. ; Polites, Stephanie F. ; Khasawneh, Mohammad A. ; Jenkins, Donald H. ; Habermann, Elizabeth B. / Is the Centers for Medicare and Medicaid Service's lack of reimbursement for postoperative urinary tract infections in elderly emergency surgery patients justified?. In: Surgery. 2014 ; Vol. 156, No. 4. pp. 1009-1015.
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abstract = "Urinary tract infections, a risk factor for readmission, have been deemed a potentially preventable problem and, therefore, not reimbursable by the Centers for Medicare and Medicaid Services since 2008. Defining the risk factors for development of urinary tract infection in the postoperative period will provide risk stratification for development of urinary tract infection in these challenging patients. Pre-, intra-, and postoperative characteristics were collected for patients ≥65 years who underwent an emergency abdominal operation from the 2005 to 2012 National Surgical Quality Improvement Program Participant User File, a database of 374 participating hospitals. In-hospital urinary tract infections occurring within 30 days of the operation were identified. Multivariable logistic regression analysis was conducted to identify risk factors of urinary tract infection. In total, 53,879 patients were included, 1,881 (3.5{\%}) of whom were diagnosed with a postoperative urinary tract infection before discharge. In-hospital urinary tract infection was associated with a longer hospital stay (27 vs 13 days, P < .001) and greater 30-day mortality rates (18{\%} vs 16{\%}, P = .003). The rate of urinary tract infection decreased from 4.5{\%} before the Centers for Medicare and Medicaid Services decree to 3.2{\%} thereafter (P < .001). Multivariable logistic regression demonstrated advanced age, female sex, insulin-dependent diabetes mellitus, dependent functional status, open wound, hypoalbuminemia, increased American Society of Anesthesiologists class, operative approach, and prolonged operative time were independent risk factors for development of postoperative urinary tract infection. Although postoperative rates of urinary tract infection decreased after the Centers for Medicare and Medicaid Services decree, the lack of reimbursement is not justified, as few modifiable risk factors to further improve postoperative urinary tract infection rates in elderly emergency surgical patients were identified. Although targeted interventions may be developed, this complication is not easily preventable and will continue to plague acute care surgeons taking care of this challenging patient population.",
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