The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer

Simon P. Kim, Nilay D Shah, Robert Jeffrey Karnes, Christopher J. Weight, Igor Frank, James P. Moriarty, Leona C. Han, Bijan J Borah, Matthew K. Tollefson, Stephen A. Boorjian

Research output: Contribution to journalArticle

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Abstract

Purpose: The incidence of hospital acquired adverse events in radical cystectomy and their implications for hospital outcomes and costs remain poorly described. We describe the incidence of hospital acquired adverse events in radical cystectomy, and characterize its relationship with in-hospital mortality, length of stay and hospitalization costs. Materials and Methods: We identified 10,856 patients who underwent radical cystectomy for bladder cancer at 1,175 hospitals in the Nationwide Inpatient Sample from 2001 to 2008. We used hospital claims to identify adverse events for accidental puncture, decubitus ulcer, deep vein thrombosis/pulmonary embolus, methicillin-resistant Staphylococcus aureus, Clostridium difficile, surgical site infection and sepsis. Logistic regression and generalized estimating equation models were used to test the associations of hospital acquired adverse events with mortality, predicted prolonged length of stay and total hospitalization costs. Results: Hospital acquired adverse events occurred in 11.3% of all patients undergoing radical cystectomy (1,228). Adverse events were associated with a higher odds of in-hospital death (OR 8.07, p <0.001), adjusted prolonged length of stay (41.3%) and total costs ($54,242 vs $26,306; p <0.001) compared to no adverse events on multivariate analysis. The incremental total costs attributable to hospital acquired adverse events were $43.8 million. Postoperative sepsis was associated with the highest risk of mortality (OR 17.56, p <0.001), predicted prolonged length of stay (62.22%) and adjusted total cost ($79,613). Conclusions: With hospital acquired adverse events occurring in approximately 11% of radical cystectomy cases, they pose a significant risk of in-hospital mortality and higher hospitalization costs. Therefore, increased attention is needed to reduce adverse events by improving patient safety, while understanding the economic implications for tertiary referral centers with possible policy changes such as denial of payment for hospital acquired adverse events.

Original languageEnglish (US)
Pages (from-to)2011-2017
Number of pages7
JournalJournal of Urology
Volume187
Issue number6
DOIs
StatePublished - Jun 2012

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Cystectomy
Urinary Bladder Neoplasms
Length of Stay
Costs and Cost Analysis
Mortality
Hospitalization
Hospital Mortality
Sepsis
Surgical Wound Infection
Clostridium difficile
Pressure Ulcer
Hospital Costs
Incidence
Patient Safety
Methicillin-Resistant Staphylococcus aureus
Embolism
Punctures
Tertiary Care Centers
Venous Thrombosis
Inpatients

Keywords

  • complications
  • costs and cost analysis
  • cystectomy
  • treatment outcome
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer. / Kim, Simon P.; Shah, Nilay D; Karnes, Robert Jeffrey; Weight, Christopher J.; Frank, Igor; Moriarty, James P.; Han, Leona C.; Borah, Bijan J; Tollefson, Matthew K.; Boorjian, Stephen A.

In: Journal of Urology, Vol. 187, No. 6, 06.2012, p. 2011-2017.

Research output: Contribution to journalArticle

Kim, Simon P. ; Shah, Nilay D ; Karnes, Robert Jeffrey ; Weight, Christopher J. ; Frank, Igor ; Moriarty, James P. ; Han, Leona C. ; Borah, Bijan J ; Tollefson, Matthew K. ; Boorjian, Stephen A. / The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer. In: Journal of Urology. 2012 ; Vol. 187, No. 6. pp. 2011-2017.
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abstract = "Purpose: The incidence of hospital acquired adverse events in radical cystectomy and their implications for hospital outcomes and costs remain poorly described. We describe the incidence of hospital acquired adverse events in radical cystectomy, and characterize its relationship with in-hospital mortality, length of stay and hospitalization costs. Materials and Methods: We identified 10,856 patients who underwent radical cystectomy for bladder cancer at 1,175 hospitals in the Nationwide Inpatient Sample from 2001 to 2008. We used hospital claims to identify adverse events for accidental puncture, decubitus ulcer, deep vein thrombosis/pulmonary embolus, methicillin-resistant Staphylococcus aureus, Clostridium difficile, surgical site infection and sepsis. Logistic regression and generalized estimating equation models were used to test the associations of hospital acquired adverse events with mortality, predicted prolonged length of stay and total hospitalization costs. Results: Hospital acquired adverse events occurred in 11.3{\%} of all patients undergoing radical cystectomy (1,228). Adverse events were associated with a higher odds of in-hospital death (OR 8.07, p <0.001), adjusted prolonged length of stay (41.3{\%}) and total costs ($54,242 vs $26,306; p <0.001) compared to no adverse events on multivariate analysis. The incremental total costs attributable to hospital acquired adverse events were $43.8 million. Postoperative sepsis was associated with the highest risk of mortality (OR 17.56, p <0.001), predicted prolonged length of stay (62.22{\%}) and adjusted total cost ($79,613). Conclusions: With hospital acquired adverse events occurring in approximately 11{\%} of radical cystectomy cases, they pose a significant risk of in-hospital mortality and higher hospitalization costs. Therefore, increased attention is needed to reduce adverse events by improving patient safety, while understanding the economic implications for tertiary referral centers with possible policy changes such as denial of payment for hospital acquired adverse events.",
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AU - Shah, Nilay D

AU - Karnes, Robert Jeffrey

AU - Weight, Christopher J.

AU - Frank, Igor

AU - Moriarty, James P.

AU - Han, Leona C.

AU - Borah, Bijan J

AU - Tollefson, Matthew K.

AU - Boorjian, Stephen A.

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N2 - Purpose: The incidence of hospital acquired adverse events in radical cystectomy and their implications for hospital outcomes and costs remain poorly described. We describe the incidence of hospital acquired adverse events in radical cystectomy, and characterize its relationship with in-hospital mortality, length of stay and hospitalization costs. Materials and Methods: We identified 10,856 patients who underwent radical cystectomy for bladder cancer at 1,175 hospitals in the Nationwide Inpatient Sample from 2001 to 2008. We used hospital claims to identify adverse events for accidental puncture, decubitus ulcer, deep vein thrombosis/pulmonary embolus, methicillin-resistant Staphylococcus aureus, Clostridium difficile, surgical site infection and sepsis. Logistic regression and generalized estimating equation models were used to test the associations of hospital acquired adverse events with mortality, predicted prolonged length of stay and total hospitalization costs. Results: Hospital acquired adverse events occurred in 11.3% of all patients undergoing radical cystectomy (1,228). Adverse events were associated with a higher odds of in-hospital death (OR 8.07, p <0.001), adjusted prolonged length of stay (41.3%) and total costs ($54,242 vs $26,306; p <0.001) compared to no adverse events on multivariate analysis. The incremental total costs attributable to hospital acquired adverse events were $43.8 million. Postoperative sepsis was associated with the highest risk of mortality (OR 17.56, p <0.001), predicted prolonged length of stay (62.22%) and adjusted total cost ($79,613). Conclusions: With hospital acquired adverse events occurring in approximately 11% of radical cystectomy cases, they pose a significant risk of in-hospital mortality and higher hospitalization costs. Therefore, increased attention is needed to reduce adverse events by improving patient safety, while understanding the economic implications for tertiary referral centers with possible policy changes such as denial of payment for hospital acquired adverse events.

AB - Purpose: The incidence of hospital acquired adverse events in radical cystectomy and their implications for hospital outcomes and costs remain poorly described. We describe the incidence of hospital acquired adverse events in radical cystectomy, and characterize its relationship with in-hospital mortality, length of stay and hospitalization costs. Materials and Methods: We identified 10,856 patients who underwent radical cystectomy for bladder cancer at 1,175 hospitals in the Nationwide Inpatient Sample from 2001 to 2008. We used hospital claims to identify adverse events for accidental puncture, decubitus ulcer, deep vein thrombosis/pulmonary embolus, methicillin-resistant Staphylococcus aureus, Clostridium difficile, surgical site infection and sepsis. Logistic regression and generalized estimating equation models were used to test the associations of hospital acquired adverse events with mortality, predicted prolonged length of stay and total hospitalization costs. Results: Hospital acquired adverse events occurred in 11.3% of all patients undergoing radical cystectomy (1,228). Adverse events were associated with a higher odds of in-hospital death (OR 8.07, p <0.001), adjusted prolonged length of stay (41.3%) and total costs ($54,242 vs $26,306; p <0.001) compared to no adverse events on multivariate analysis. The incremental total costs attributable to hospital acquired adverse events were $43.8 million. Postoperative sepsis was associated with the highest risk of mortality (OR 17.56, p <0.001), predicted prolonged length of stay (62.22%) and adjusted total cost ($79,613). Conclusions: With hospital acquired adverse events occurring in approximately 11% of radical cystectomy cases, they pose a significant risk of in-hospital mortality and higher hospitalization costs. Therefore, increased attention is needed to reduce adverse events by improving patient safety, while understanding the economic implications for tertiary referral centers with possible policy changes such as denial of payment for hospital acquired adverse events.

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KW - treatment outcome

KW - urinary bladder neoplasms

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