The impact of patient age and comorbidities on the occurrence of “never events” in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample

Abstract

Object As health care administrators focus on patient safety and cost-effectiveness, methodical assessment of quality outcome measures is critical. In 2008 the Centers for Medicare and Medicaid Services (CMS) published a series of “never events” that included 11 hospital-acquired conditions (HACs) for which related costs of treatment are not reimbursed. Cerebrovascular procedures (CVPs) are complex and are often performed in patients with significant medical comorbidities. Methods This study examines the impact of patient age and medical comorbidities on the occurrence of CMS-defined HACs, as well as the effect of these factors on the length of stay (LOS) and hospitalization charges in patients undergoing common CVPs. Results The HACs occurred at a frequency of 0.49% (1.33% in the intracranial procedures and 0.33% in the carotid procedures). Falls/trauma (n = 4610, 72.3% HACs, 357 HACs per 100,000 CVPs) and catheter-associated urinary tract infections (n = 714, 11.2% HACs, 55 HACs per 100,000 CVPs) were the most common events. Age and the presence of ≥ 2 comorbidities were strong independent predictors of HACs (p < 0.0001). The occurrence of HACs negatively impacts both LOS and hospital costs. Patients with at least 1 HAC were 10 times more likely to have prolonged LOS (≥ 90th percentile) (p < 0.0001), and 8 times more likely to have high inpatient costs (≥ 90th percentile) (p < 0.0001) when adjusting for patient and hospital factors. Conclusions Improved quality protocols focused on individual patient characteristics might help to decrease the frequency of HACs in this high-risk population. These data suggest that risk adjustment according to underlying patient factors may be warranted when considering reimbursement for costs related to HACs in the setting of CVPs.

Never events and hospital-acquired conditions after kidney transplant

“…Also, the risks of other postoperative complications such as prolonged ileus, pneumonia, acute myocardial infarction, and respiratory failure increase in presense of NE and HAC. We reinforce the literatures reports on the severity effect of NE and HAC events on outcomes of patient as well as the significant increase in total hospital charges related to the events [7][8][9] .…”

The july effect: An analysis of never events in the nationwide inpatient sample

“…HACs include complications such as air embolism, retained foreign body, blood incompatibility, pressure ulcer, catheter‐associated urinary tract infection (UTI), vascular catheter‐associated infection, manifestations of poor glycemic control, falls/trauma, deep venous thrombosis or pulmonary embolism after total knee and hip replacements, surgical site infections after coronary artery bypass graft, and surgical site infections after certain orthopedic or bariatric surgeries. Prior studies have utilized HACs as a metric for quality of healthcare delivery in subspecialties such as cerebrovascular surgery, bowel surgery, and urology …”

Impact of the 2003 ACGME Resident Duty Hour Reform on Hospital-Acquired Conditions: A National Retrospective Analysis

“…15 HACs have been utilized as hospital quality outcome measures in studies. 10,11,16,17 No prior study has evaluated the national incidence of HACs before and after the institution of the 2003 ACGME duty hour limits. Each discharge was treated as an independent event due to the lack of unique patient identifiers.…”