Surgical never events in the United States

Mehtsun, Winta T.; Ibrahim, Andrew M.; Diener‐West, Marie; Pronovost, Peter J.; Makary, Martin A.

doi:10.1016/j.surg.2012.10.005

Cited by 121 publications

(74 citation statements)

References 27 publications

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“…1). 6,[9][10][11]15 Although CMS has yet to expand the definition of never event to DVT/PE following spinal surgery, new rulings such as the addition of "radiological never events" in 2011 are evidence of the ongoing expansion of the program.…”

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confidence: 99%

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Hospital charges associated with “never events”: comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty

Daniels

Kawaguchi

Contag

et al. 2016

SPI

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OBJECTIVE Beginning in 2008, the Centers for Medicare and Medicaid Service (CMS) determined that certain hospital-acquired adverse events such as surgical site infection (SSI) following spine surgery should never occur. The following year, they expanded the ruling to include deep vein thrombosis (DVT) and pulmonary embolism (PE) following total joint arthroplasty. Due to their ruling that “never events” are not the payers' responsibility, CMS insists that the costs of managing these complications be borne by hospitals and health care providers, rather than billings to health care payers for additional care required in their management. Data comparing the expected costs of such adverse events in patients undergoing spine and orthopedic surgery have not previously been reported. METHODS The California State Inpatient Database (CA-SID) from 2008 to 2009 was used for the analysis. All patients with primary procedure codes indicating anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), lumbar laminectomy (LL), total knee replacement (TKR), and total hip replacement (THR) were analyzed. Patients with diagnostic and/or treatment codes for DVT, PE, and SSI were separated from patients without these complication codes. Patients with more than 1 primary procedure code or more than 1 complication code were excluded. Median charges for treatment from primary surgery through 3 months postoperatively were calculated. RESULTS The incidence of the examined adverse events was lowest for ACDF (0.6% DVT, 0.1% PE, and 0.03% SSI) and highest for TKA (1.3% DVT, 0.3% PE, 0.6% SSI). Median inpatient charges for uncomplicated LL was $51,817, compared with $73,432 for ACDF, $143,601 for PLIF, $74,459 for THR, and $70,116 for TKR. Charges for patients with DVT ranged from $108,387 for TKR (1.5 times greater than index) to $313,536 for ACDF (4.3 times greater than index). Charges for patients with PE ranged from $127,958 for TKR (1.8 times greater than index) to $246,637 for PLIF (1.7 times greater than index). Charges for patients with SSI ranged from $168,964 for TKR (2.4 times greater than index) to $385,753 for PLIF (2.7 times greater than index). CONCLUSIONS Although incidence rates are low, adverse events of spinal procedures substantially increase the cost of care. Charges for patients experiencing DVT, PE, and SSI increased in this study by factors ranging from 1.8 to 4.3 times those for patients without such complications across 5 common spinal and orthopedic procedures. Cost projections by health care providers will need to incorporate expected costs of added care for patients experiencing such complications, assuming that the cost burden of such events continues to shift from payers to providers.

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mentioning

confidence: 99%

“…6,8,10,15 In the present study, we used a billing database to compare the relative charges for patients experiencing SSI, DVT, and PE following anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), lumbar laminectomy (LL), total knee replacement (TKR), and total hip replacement (THR).…”

mentioning

confidence: 99%

Hospital charges associated with “never events”: comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty

Daniels

Kawaguchi

Contag

et al. 2016

SPI

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“…NE and HACs also have a significant financial impact on the US healthcare system 3 . It has been estimated that payments for surgical NE amounted to over $1.3 billion during 1990 -2010 4 . Eliminating surgical NEs is necessary to limit harm to patients 4 .…”

Section: Introductionmentioning

confidence: 99%

“…It has been estimated that payments for surgical NE amounted to over $1.3 billion during 1990 -2010 4 . Eliminating surgical NEs is necessary to limit harm to patients 4 . Understanding the impact and frequency of these conditions can help to design the best preventative strategies.…”

Section: Introductionmentioning

confidence: 99%

Never events and hospital-acquired conditions after kidney transplant

Moghadamyeghaneh

Chen

Alameddine

et al. 2017

CUAJ

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Introduction: Never events (NE) and hospital-acquired conditions (HAC) after surgery have been designated as quality metrics in healthcare by the centres for Medicare and Medicaid Services (CMS). Methods: The Nationwide Inpatient Sample (NIS) database 2002-2012 was used to identify patients underwent kidney transplant. Multivariate analysis using logistic regression was used to identify outcomes and risk factors of HAC and NE after transplantation; however, we were limited by using a retrospective database missing some important variables specified for the kidney transplant, such as some operative factors, donor factors, and cold and warm ischemia times. Results: Among 35 058 patients who underwent kidney transplant, there were 11 NEs, all of which were due to retained foreign bodies. Among HAC after surgery, falling was the most common (44.9%), followed by poor glycemic control (21.7%), vascular catheter-associated infection (21%), and catheter-associated urinary tract infection (8%). HAC and NE after surgery lead to a significant increase in mortality (adjusted odds ratio [AOR] 2.49; p=0.04), hospitalization length (13 vs. 7 days; p<0.01), and total hospital charges ($231 801 vs. $146 717; p<0.01). A significantly higher risk of HAC or NE was seen for patients who had more loss of function before surgey (AOR 3.25; p<0.01) and patients expected to have higher postoperative mortality before operation (AOR 1.62; p=0.03).

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“…Such ''never'' events in fact occur rarely, but occur sufficiently often over time as to affect not only quality of care, but also cost of care and liability. Pronovost et al have estimated that there are probably 4,000 such surgical ''should never happen'' events per year, on the basis of their 20-yr review of 9,740 paid malpractice claims for such events in the National Practitioner Databank [67].…”

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confidence: 99%