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Cost of potentially preventable complications in surgical patients

Posted Oct 05 2009 10:03pm

The cumulative additional cost of potentially preventable complications in surgical patients may be as high as 1.5 billion dollars a year.   Encinosa and Hellinger (Health Services Research, early view July 2008, DOI:10.1111/j.1475-6773.2008.00882.x) examined 5.6 million enrollees in the 2001- 2002 MarketScan Commercial Claims and Encounters Database (a data base of medical care claims data for 45 very large employer-sponsored benefit plans) and identified 161,004 patients with a major surgery admission who did not have another admission for major surgery within the prior 90 days.   The authors examined 14 patient safety indicators (PSI) which were grouped into technical problems (anesthesia complications, accidental lacerations, foreign body left in, transfusion reaction and similar events), infections (related to medical care, sepsis), pulmonary and vascular problems (pulmonary embolism and DVT), acute respiratory failure, metabolic problems, wound problems (such as hematoma or dehiscence) and nursing sensitive events (post op hip fracture, decubitus ulcers for example).   They identified 4,140 pts with an identified PSI and matched them to patients without an identified PSI.   They found that 2.6% of the patients who underwent major surgery had at least one of the 14 PSIs.   About 5.6% of this group had more than one PSI.   Patients with PSIs had a 90 day death rate of 6.3% compared to 0.6 in those without a PSI.   The 90 day readmission rate was 15% compared to 5.5%.   The 90 day cost for surgery was $66,879 on the average in those with PSIs compared to $18,284 for those without.   Post operative acute respiratory failure was the most expensive of the PSI groups costing $106,370 over the 90 day period and it had the highest 90 day death rate (12%).   Infection however had the highest readmission rate.   This is one of the first papers to determine complication rates and their costs beyond the period of hospitalization.   Costs from PSI continue after discharge.   The database represents a non medicare population and includes 4% of the commercially insured individuals in the United States.   The 14 PSIs examined account for 11% of the 90 days deaths, 2% of 90 day readmissions, and 2% of all 90 day expenditures after major surgery.   Decreasing the incidence of these PSIs could greatly decrease medical costs and improve the “bottom” line of acute care institutions.

 

David S. Smith, M.D., Ph.D.

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