How different are complications that affect the older adult inpatient?

Rowell, David; Nghiem, Son; Jorm, Christine; Jackson, Terri

doi:10.1136/qshc.2009.032235

Cited by 7 publications

(16 citation statements)

References 17 publications

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“…The increased LOS of 3.6 days attributable to the four key complications is similar to other research, ranging from 1 to 9 days [ 22 ]. Complications are more common in older adult inpatients and, though no more costly, they occur more often [ 4 ]. Similarly, we found that, once a complication occurs, the cost is similar for people with and without dementia but they occur more often among dementia patients.…”

Section: Discussionmentioning

confidence: 99%

“…Study limitations include a reliance on hospital discharge data, though we are fortunate that Australia’s hospital data reliability and quality is highly regarded since the worldwide initiation of data dictionaries in the early 1990s (see [ 28 ]), and the study is strengthened by a comprehensive approach to data linkage modelled by the Australian Institute of Health and Welfare. Other limitations are the lack of ‘condition-onset flags’ [ 4 ] to improve accuracy in identifying hospital-acquired complications. However, our patient-level risk-adjustment approach is the most refined method currently published with this level of costing detail for the aged population.…”

Section: Discussionmentioning

confidence: 99%

“…Though people aged over 65 use nearly one-half (48%) of hospital bed days [ 2 ], there are few studies of hospital-acquired complications in this population [ 3 ]. The costs associated with this group are likely to be substantial as patients over 70 years have higher rates of mental state alterations, such as delirium, and urinary and respiratory tract infections [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study

Bail

Goss

Draper

et al. 2015

BMC Health Serv Res

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BackgroundIncreased length of stay and high rates of adverse clinical events in hospitalised patients with dementia is stimulating interest and debate about which costs may be associated and potentially avoided within this population.MethodsA retrospective cohort study was designed to identify and compare estimated costs for older people in relation to hospital-acquired complications and dementia. Australia’s most populous state provided a census sample of 426,276 discharged overnight public hospital episodes for patients aged 50+ in the 2006–07 financial year. Four common hospital-acquired complications (urinary tract infections, pressure areas, pneumonia, and delirium) were risk-adjusted at the episode level. Extra costs were attributed to patient length of stay above the average for each patient’s Diagnosis Related Group, with separate identification of fixed and variable costs (all in Australian dollars).ResultsThese four complications were found to be associated with 6.4% of the total estimated cost of hospital episodes for people over 50 (A$226million/A$3.5billion), and 24.7% of the estimated extra cost of above-average length of stay spent in hospital for older patients (A$226million/A$914million). Dementia patients were more likely than non-dementia patients to have complications (RR 2.5, p <0.001) and these complications comprised 22.0% of the extra costs (A$49million/A$226million), despite only accounting for 10.4% of the hospital episodes (44,488/426,276). For both dementia and non-dementia patients, the complications were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and doubled the increased estimated mean episode cost (199%, or A$16,403/A$8,240).ConclusionUrinary tract infections, pressure areas, pneumonia and delirium are potentially preventable hospital-acquired complications. This study shows that they produce a burdensome financial cost and reveals that they are very important in understanding length of stay and costs in older and complex patients. Once a complication occurs, the cost is similar for people with and without dementia. However, they occur more often among dementia patients. Advances in models of care, nurse skill-mix and healthy work environments show promise in prevention of these complications for dementia and non-dementia patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study

Bail

Goss

Draper

et al. 2015

BMC Health Serv Res

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“…Similar complications average almost four times the LOS of separations than those without complications [ 15 ]. These common but relatively inexpensive (per case) complications, such as urinary tract infections and pneumonias, tend to cost the most to health systems because they are so common [ 34 ]. The combined cost of just four common hospital-acquired complications (urinary tract infections, pressure injuries, pneumonia and delirium) was found to be associated with 25% of the above-average length of stay in one Australian state among older adults, with eightfold increase in LOS, and double the estimated mean episode cost [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications

et al. 2018

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BackgroundHospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established.MethodTo investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient’s Diagnosis Related Group from hospital discharge data.ResultsFor adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001).DiscussionHospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective.ConclusionsComplications and dementia were found to cost more than other kinds of inpatient complexity.

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“…Furthermore, we determined baseline kidney function before hospitalization using outpatient laboratory data to define both eGFR and proteinuria. Prior studies have focused largely on specific populations of hospitalized patients, such as those defined by age, diagnostic category (cardiac surgery, intensive care unit, and post-myocardial infarction) or treatment by a specific health care provider or institution, thereby limiting their generalizability (17)(18)(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

Risk of Hospital-Acquired Complications in Patients with Chronic Kidney Disease

Bohlouli

Jackson

Hemmelgam

et al. 2016

CJASN

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Background and objectives Unintended injuries or complications in hospitalized patients are common, potentially preventable, and associated with adverse consequences, including greater mortality and health care costs. Patients with CKD may be at higher risk of hospital-acquired complications (HACs).Design, setting, participants, & measurements Adults from a population-based cohort (Alberta Kidney Disease Network) who were hospitalized from April 1, 2003, to March 31, 2008, made up the study cohort. Kidney function was defined using outpatient eGFR and proteinuria (protein-to-creatinine ratio or dipstick) in the year before index hospitalization. Comorbid conditions were identified using validated algorithms applied to administrative data. A specific diagnostic indicator was used to identify HACs. Complications were classified into clinically homogeneous groups and subclassified as potentially preventable (p-HACs) or always preventable (a-HACs). Multivariable logistic regressions models were used to examine the association of CKD with HACs, accounting for confounders.Results Of 536,549 patients, 8.5% had CKD; those with CKD were older and more likely to be admitted for circulatory system diseases than those without CKD. In fully adjusted models, the odds ratio (OR) of any hospital complication in patients with CKD (reference: no CKD) was 1.19 (95% confidence interval [95% CI], 1.18 to 1.26); there was a graded relation between the risk of HACs and CKD severity, with an OR of 1.81 (95% CI, 1.51 to 2.17) in those with the most severe CKD (eGFR, 15-29 ml/min per 1.73 m 2 and proteinuria, .30 mg/mmol). Findings were similar for p-HACs (OR, 1.20 [95% CI, 1.16 to 1.24] and 1.78 [95% CI, 1.43 to 2.11], respectively). The a-HACs had similar point estimates.Conclusions The presence of CKD and its severity are associated with a higher risk of HACs, including those considered preventable. Targeted strategies to reduce complications in patients with CKD admitted to the hospital should be considered.

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How different are complications that affect the older adult inpatient?

Cited by 7 publications

References 17 publications

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study

The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study

Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications

Risk of Hospital-Acquired Complications in Patients with Chronic Kidney Disease

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