Abstract
BackgroundRecent policy initiatives, including Bundled Payments for Care Improvement (BPCI) Initiative by the Centers for Medicare and Medicaid Health Services (CMS), encourage healthcare providers to manage the total episode of care, rather than just the surgical episode. Surgical site infections (SSI) following total joint replacement result in preventable morbidity and suffering for patients and excess healthcare utilization for healthcare providers. This study sought to estimate the additional resources associated with SSIs within the 90-day episode of care following hip and knee joint replacement.MethodsUsing the 2013 Nationwide Readmissions Database (NRD), healthcare resource utilization was compared between propensity score matched patient groups with and without SSI-related readmissions within the 90-day episode of care following total joint replacement.ResultsSurgical site infections were associated with significantly longer hospital length of stay and increased costs following hip and knee joint replacement procedures. Generalized estimating equation regression results confirmed that additional costs associated with SSIs following both cohorts were significant, with additional hospital length of stay and costs following total hip and knee replacement procedures ranging from 4.9 to 5.2 days and $12,689 to $12,890, respectively.ConclusionSurgical site infections following total joint replacement account for significant additional healthcare resource use within the 90-day episode of care.
Highlights
As life expectancy continues to improve, healthcare administrators anticipate a corresponding rise in the incidence of total joint replacement, primary hip and knee procedures [1,2,3]
We focused on only readmissions that identified surgical site infections as the primary cause of readmission
Surgical site infections following total joint replacement are associated with significant healthcare costs within the 90-day episode of care
Summary
As life expectancy continues to improve, healthcare administrators anticipate a corresponding rise in the incidence of total joint replacement, primary hip and knee procedures [1,2,3]. The current study sought to estimate the incidence and additional economic burden associated with surgical site infections within the 90-day episode of care period using the National Readmissions Database (NRD) of the Healthcare Cost and Utilization Project (HCUP). This unique database captures information on discharges with and without repeat hospital visits per year, allowing for the longitudinal study of patient populations through a 12-month period, such that readmissions and associated resource use following an event of interest can be captured and followed over time. This study sought to estimate the additional resources associated with SSIs within the 90-day episode of care following hip and knee joint replacement
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