TY - JOUR
T1 - Hospital variation in postoperative infection and outcome after congenital heart surgery
AU - Pasquali, Sara K.
AU - He, Xia
AU - Jacobs, Marshall L.
AU - Hall, Matthew
AU - Gaynor, J. William
AU - Shah, Samir S.
AU - Peterson, Eric D.
AU - Hill, Kevin D.
AU - Li, Jennifer S.
AU - Jacobs, Jeffrey P.
N1 - Funding Information:
This study suggests that initiatives aimed at reducing infection after congenital heart surgery may play a role in reducing variation in LOS and costs across centers. However, given that infection rates alone explained relatively little of the total variation in these outcomes across hospitals, further study is needed to identify other factors in addition to postoperative infection which may be targeted in quality improvement initiatives. The following authors have received support: National Heart, Lung, and Blood Institute ( 1K08HL103631 , principal investigator (PI): Pasquali; 1RC1HL099941 , co-PIs: J Jacobs, Li); Dr Shah, National Institute of Allergy and Infectious Diseases ( K01AI73729 ) and Robert Wood Johnson Foundation Physician Faculty Scholar program.
PY - 2013/8
Y1 - 2013/8
N2 - Background: Several initiatives aim to reduce postoperative infection across a variety of surgical patients as a means to improve overall quality of care and reduce variation across centers. However, the association of infection rates with hospital-level outcomes and resource utilization has not been well described. We evaluated this association across a multicenter cohort undergoing congenital heart surgery. Methods: The Society of Thoracic Surgeons Congenital Heart Surgery Database was linked to resource utilization data from the Pediatric Health Information Systems Database for hospitals participating in both (2006 to 2010). Hospital-level infection rates (sepsis, wound infection, mediastinitis, endocarditis, pneumonia) adjusted for patient risk factors and case mix were calculated using Bayesian methodology, and association with hospital mortality rates, postoperative length of stay (LOS), and total costs evaluated. Results: The cohort included 32,856 patients (28 centers); 3.7% had a postoperative infection. Across hospitals, the adjusted infection rate varied from 0.9% to 9.8%. Hospitals with the highest infection rates had longer (LOS) (13.2 vs 11.7 days, p < 0.001) and increased hospital costs ($71,100 vs $65,100, p < 0.001), but similar mortality rates (odds ratio 0.99, 95% confidence interval 0.80 to 1.21, p = 0.9). The proportion of variation in costs and LOS explained by infection was 15% and 6%, respectively. Conclusions: Infection after congenital heart surgery contributes to prolonged LOS and increased costs on a hospital level. However, given that infection rates alone explained relatively little of the variation in these outcomes across hospitals, further study is needed to identify additional factors that may be targeted in initiatives to reduce variation and improve outcomes across centers.
AB - Background: Several initiatives aim to reduce postoperative infection across a variety of surgical patients as a means to improve overall quality of care and reduce variation across centers. However, the association of infection rates with hospital-level outcomes and resource utilization has not been well described. We evaluated this association across a multicenter cohort undergoing congenital heart surgery. Methods: The Society of Thoracic Surgeons Congenital Heart Surgery Database was linked to resource utilization data from the Pediatric Health Information Systems Database for hospitals participating in both (2006 to 2010). Hospital-level infection rates (sepsis, wound infection, mediastinitis, endocarditis, pneumonia) adjusted for patient risk factors and case mix were calculated using Bayesian methodology, and association with hospital mortality rates, postoperative length of stay (LOS), and total costs evaluated. Results: The cohort included 32,856 patients (28 centers); 3.7% had a postoperative infection. Across hospitals, the adjusted infection rate varied from 0.9% to 9.8%. Hospitals with the highest infection rates had longer (LOS) (13.2 vs 11.7 days, p < 0.001) and increased hospital costs ($71,100 vs $65,100, p < 0.001), but similar mortality rates (odds ratio 0.99, 95% confidence interval 0.80 to 1.21, p = 0.9). The proportion of variation in costs and LOS explained by infection was 15% and 6%, respectively. Conclusions: Infection after congenital heart surgery contributes to prolonged LOS and increased costs on a hospital level. However, given that infection rates alone explained relatively little of the variation in these outcomes across hospitals, further study is needed to identify additional factors that may be targeted in initiatives to reduce variation and improve outcomes across centers.
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U2 - 10.1016/j.athoracsur.2013.04.024
DO - 10.1016/j.athoracsur.2013.04.024
M3 - Article
C2 - 23816416
AN - SCOPUS:84881135744
SN - 0003-4975
VL - 96
SP - 657
EP - 663
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -