Medical injuries can increase mortality risk and incur additional costs

Abstract

Question What is the effect of medical injury on risk of mortality, length of stay in hospital and associated costs? Study design Outcomes analysis: hospital discharge data. Main results The increased length of stay following patient safety indicator events ranged from 0 days (injury to neonate) to 10.89 days (postoperative sepsis). Additional costs ranged from $0 (obstetric trauma without vaginal instrumentation) to $57,727 (postoperative sepsis). Increased mortality ranged from 0% (obstetric trauma) to 21.9% (postoperative sepsis). Twelve of the 18 patient safety indicator events generated significant increases to mortality rate (see Table 1). Table 1 Outcomes for Patient Safety Indicator events occurring at a rate ≥1 per 1000 discharges. Patient Safety Indicator Event Rate per 1000 discharges at risk Excess mortality, % ( p value) * Excess length of hospital stay, days ( p value) * Excess cost, US $ ( p value) * Obstetric trauma, vaginal birth with instrumentation 224.21 0 (0.32) 0.07 (<0.001) 220 (0.3) Obstetric trauma, vaginal birth without instrumentation 86.61 0 (>0.99) 0.05 (0.01) −93 (0.16) Decubitus ulcer 21.51 7.23 (<0.001) 3.98 (0.10) 10,845 (<0.001) Sepsis (postoperative) 11.25 21.92 (<0.001) 10.89 (<0.001) 57,727 (<0.001) Pulmonary embolism or DVT (postoperative) 9.34 6.56 (<0.001) 5.36 (0.15) 21,709 (<0.001) Obstetric trauma, caesarean birth 6.97 −0.02 (0.32) 0.43 (0.003) 2718 (<0.001) Birth trauma, injury to neonate 6.53 −0.08 (0.27) −0.09 (0.27) 298 (0.32) Respiratory failure (postoperative) 3.58 21.84 (<0.001) 9.08 (<0.001) 53,502 (<0.001) Puncture or laceration, accidental 3.32 2.16 (<0.001) 1.34 (<0.001) 8271 (<0.001) Haemorrhage or haematoma (postoperative) 2.06 3.01 (<0.001) 3.94 (<0.001) 21,431 (<0.001) Wound dehiscence 2.05 9.63 (<0.001) 9.42 (<0.001) 40,323 (<0.001) Infection due to medical care 1.99 4.31 (<0.001) 9.58 (<0.001) 38,656 (<0.001) Physiologic and metabolic derangement (postoperative) 1 19.81 (<0.001) 19.81 (<0.001) 54,818 (<0.001) *Data are mean values. Excess length of stay, mortality and costs are the difference between a case and matching controls. Paired t test used to test if mean excess differed significantly from zero. Authors’ conclusions The effect of injuries experienced while in hospital varies enormously, which can result in significant increases to risk of mortality, length of hospital stay and cost.