Incidence Of Hospital-acquired Conditions Research Articles

Impact of Repeated Reimbursement Penalties on Hospital Total Quality Scores.

The incidence of hospital-acquired conditions (HACs) is a serious public health issue with implications ranging from patient morbidity and mortality to negative financial impacts on patients and health care systems. Despite substantial efforts to address and reduce HACs, research into the effect of quality improvement programs is inconclusive. This study seeks to better understand the relationship between repeated reimbursement penalties and improvement in HAC quality scores. A quantitative comparative analysis of U.S. health care data was conducted. Data on quality outcomes and hospital characteristics were sourced from the Hospital-Acquired Condition Reduction Program from fiscal years 2018 and 2019 and the Centers for Medicare & Medicaid Services Inpatient Prospective Payment System impact files, respectively. In total, 3123 U.S. hospitals were analyzed to compare differences between total HAC scores of hospitals with and without penalties in consecutive years. Hospitals with repeated penalties had significantly greater improvement in scores ( t497.262 = -13.00, P < 0.001), and the impact was greatest in small hospitals (<100 beds). Repeated penalties had a smaller impact on disproportionate share hospitals (Cohen d = 0.73). Among all hospitals, the effect of repeated penalties was large (Cohen d = 0.75). This study suggests that repeated penalties can improve quality scores in U.S. hospitals. However, the effect may be exaggerated for smaller hospitals and those that serve patient populations with a relatively higher socioeconomic status. The reason disproportionate share hospitals did not show as much improvement as nondisproportionate hospitals may be because hospitals serving vulnerable populations often have fewer resources.

Incidence of Hospital-Acquired Conditions During Pediatric Clinical Research Inpatient Hospitalizations: A Matched Cohort Study.

In this matched cohort study using data from pediatric hospitals, we compared the incidence of hospital-acquired conditions (HACs) during clinical research hospitalizations to nonresearch hospitalizations. Using Pediatric Health Information System data for inpatient discharges January 2017-June 2022, we matched research hospitalizations (identified by International Classification of Diseases, Tenth Revision, diagnosis code) to nonresearch hospitalizations within hospital on age (±3 y), sex, discharge year (±2), and All Patients Refined Diagnosis Related Groups classification, severity of illness (±1), and risk of mortality (±1). We calculated the incidence (per 1000 discharges) and incidence rate (per 10,000 patient days) of HAC identified by International Classification of Diseases, Tenth Revision, codes and compare research versus nonresearch using logistic and Poisson regression, accounting for matching using generalized estimating equations and adjusting for sociodemographic factors and hospital utilization. We matched 7000 research hospitalizations to 26,447 nonresearch from 28 hospitals. Median age was 6.0 years (interquartile range, 10.6 y). Median length of stay was 4.0 days (interquartile range, 11.0 days) with longer stays among research hospitalizations ( P < 0.001). Incidence of HAC among research hospitalizations was 13.1 versus 7.2 per 1000 for nonresearch ( P < 0.001) and incidence rate 6.7 versus 4.5 per 10,000 patient days. Adjusting for sociodemographic and clinical factors, research stays had 1.65 times the odds of any HAC (95% confidence interval, 1.27-2.16; P < 0.001) and 1.38 times the incidence rate (95% confidence interval, 1.09-1.75; P = 0.009). Our findings indicate that pediatric research hospitalizations are more likely to experience HACs compared with nonresearch hospitalizations. These findings have important safety implications for pediatric inpatient clinical research that warrant further study.

Effects of Hospital-Acquired Conditions on Readmission Risk: The Mediating Role of Length of Stay

Problem definition: Hospital-acquired conditions (HACs) represent undesirable complications that occur during a hospital stay. HACs can compromise patient safety and care outcomes and result in unnecessary socio-economic costs. Although hospitals are expected to reduce the incidence of HACs, few studies have examined the implications of HACs on other clinical outcomes and measures of hospital performance. This study contributes to the literature by exploring the relationship between exposure to a set of target HACs, length of stay (LOS) performance, and 30-day readmission risk. Methodology/results: To estimate the effects of HACs, we conduct econometric analyses using patient-visit-level data for heart attack, heart failure, and pneumonia patients hospitalized in the U.S. state of Florida during 2010–2014. We define LOS performance as the deviation of LOS from the Geometric Mean LOS (GMLOS), a standard LOS set by the Centers for Medicare and Medicaid Services. First, we find that exposure to HACs leads to a 37% increase in the odds of readmission and a 79% increase in LOS. Second, an increase in LOS is associated with a decrease in readmission risk, and this decrease is stronger for patients exposed to HACs. Third, LOS performance mediates the HACs-readmission risk relationship, such that the increase in the readmission risk of a HAC patient can be fully suppressed by the patient’s LOS. Fourth, we find that for patients exposed to HACs, the benefits of a longer LOS are almost entirely capitalized when the LOS becomes 65% longer than the GMLOS. Managerial implications: We demonstrate that, when addressing the consequences of HACs, clinicians also face indirectly a trade-off between reducing readmissions and controlling costs. We proffer LOS as a potential mechanism under hospitals’ control for mitigating the adverse effects of HACs on readmission risk. Thus, this study offers guidance to clinicians having to decide when to discharge patients with exposure to HACs. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0088 .

211. Patient, surgery, and hospital-related risk factors for hospital acquired conditions following common spinal procedures during inpatient stays

<h3>BACKGROUND CONTEXT</h3> A total of 48,771 hospital-acquired conditions (HACs) have been reported in United States hospitals. These incidents resulted in excess costs of more than $2 billion, which translated to roughly $40,000 per patient per HAC. Along with this direct fiscal burden, enduring an HAC added on average 8.17 days to each patient's hospital stay, which can lead to indirect hidden costs. <h3>PURPOSE</h3> To critically analyze the classical and novel risk factors of HACs following the most prevalent inpatient spine procedures; spinal fusion (463,200 cases/year) and laminectomy (438,200 cases/year). <h3>STUDY DESIGN/SETTING</h3> Systematic review of observational cohort studies. <h3>PATIENT SAMPLE</h3> This study included 6,382 patients who underwent spine fusion or laminectomy. <h3>OUTCOME MEASURES</h3> Patient-, surgical-, hospital-, related risk factors and genetic associations. <h3>METHODS</h3> Several online databases were searched. Using illustrated figures and diagrams, we aim to provide spine surgeons with the knowledge and evidence about the economic impact, patient-, surgery-, and hospital-related risk factors of HACs. Additionally, we present the novel risk factors such as genetic biomarkers. <h3>RESULTS</h3> Patients undergoing fusion and laminectomy experience HACs at rates of 1.4% and 6.5%, respectively. The incidence of HACs most commonly comprises falls and trauma (87%) and SSIs (11%) for thoracolumbar fusion patients, while laminectomy patients experience venous thromboembolism (VTE) (1.4%) and surgical site infection (SSI) (0.2%) most frequently. Increased age is correlated with higher incidence of HACs. Complication rates in those over 65 are as high as 13.46% with wound complications (1.2%-1.69% of cases) and deep vein thrombosis (DVT) (2.1-2.2%) occurring at rates greater than that of those under 65. BMI less than 40 is associated with increased risk of VTE events and SSI, whereas those over 40 have higher risk of urinary tract infection (UTI). Patients who have had previous spinal surgery have a strong risk of developing wound complications (4.6% vs 1.0% among those without prior surgery). Insulin-dependent diabetes (OR=1.72) may increase the rate of complications and deep SSI following thoracolumbar spinal surgery (p=0.050). Steroid use (OR=1.55) may increase a patient's likelihood of complication. Patients with a preoperative psychiatric disorder are at greater risk of a surgical complication. Regarding hospital-related factors, increased operative time is associated with greater risk of HACs. In patients over the age of 75, the length of operation time (p=0.003) is a contributing factor to wound complications. Moreover, teaching hospitals and those with larger bed sizes may be associated with increased risk for HACs. Lastly, weekend admissions are associated with a 45.3% HAC incidence rate compared to a 4.59% rate in weekday admissions. However, higher surgeon volume is associated with lower complications. The pre-admission testing for novel genetic biomarkers of HACs could stratify the risk of HACs for patients. Patients with higher concentrations of miR-582, miR-195, miR- 532, nitric oxide synthase 3 polymorphism are at higher risk to develop VTE. <h3>CONCLUSIONS</h3> Identifying patient-, surgery-, and hospital- related risk factors in the setting of fusion and laminectomy is crucial to providing patients with optimal care and avoiding the penalties of HACs. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Frailty Severity Impacts Development of Hospital-acquired Conditions in Patients Undergoing Corrective Surgery for Adult Spinal Deformity.

This was a retrospective cohort study of a national dataset. The purpose of this study was to consider the influence of frailty on the development of hospital-acquired conditions (HACs) in adult spinal deformity (ASD). HACs frequently include reasonably preventable complications. Eleven events are identified as HACs by the Affordable Care Act. In the surgical ASD population, factors leading to HACs are important to identify to optimize health care. Patients 18 years and older undergoing corrective surgery for ASD identified in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP). The relationship between HACs and frailty as defined by the NSQIP modified 5-factor frailty index (mFI-5) were assessed using χ2 and independent sample t tests. The mFI-5 is assessed on a scale 0-1 [not frail (NF): <0.3, mildly frail (MF): 0.3-0.5, and severely frail (SF): > 0.5]. Binary logistic regression measured the relationship between frailty throughout HACs. A total of 9143 ASD patients (59.1 y, 56% female, 29.3 kg/m2) were identified. Overall, 37.6% of procedures involved decompression and 100% fusion. Overall, 6.5% developed at least 1 HAC, the most common was urinary tract infection (2.62%), followed by venous thromboembolism (2.10%) and surgical site infection (1.88%). According to categorical mFI-5 frailty, 82.1% of patients were NF, 16% MF, and 1.9% SF. Invasiveness increased with mFI-5 severity groups but was not significant (NF: 3.98, MF: 4.14, SF: 4.45, P>0.05). Regression analysis of established factors including sex [odds ratio (OR): 1.22; 1.02-146; P=0.030], diabetes mellitus (OR: 0.70; 0.52-0.95; P=0.020), total operative time (OR: 1.01; 1.00-1.01; P<0.001), body mass index (OR: 1.02; 1.01-1.03; P=0.008), and frailty (OR: 8.44; 4.13-17.26; P<0.001), as significant predictors of HACs. Overall, increased categorical frailty severity individually predicted increased total length of stay (OR: 1.023; 1.015-1.030; P<0.001) and number of complications (OR: 1.201; 1.047-1.379; P=0.009). For patients undergoing correction surgery for ASD, the incidence of HACs increased with worsening frailty score. Such findings suggest the importance of medical optimization before surgery for ASD.

Impact of Medicare's Nonpayment Program on Hospital-acquired Conditions.

Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. To determine whether the Program was associated with changes in HAC incidence, and whether this association varies across hospitals with differential Medicare patient load. Quasi-experimental study using difference-in-differences estimation. Incidence of HACs before and after Program implementation was compared across hospital MUR quartiles. A total of 867,584 elderly Medicare stays for acute myocardial infarction, congestive heart failure, pneumonia, and stroke that were discharged from 159 New York State hospitals from 2005 to 2012. For descriptive analysis, hospital-level mean HAC rates by month, MUR quartile, and Program phase are reported. For multivariate analysis, primary outcome is incidence of the any-or-none indicator for occurrence of at least 1 of 6 HACs. Secondary outcomes are the incidence of each HAC. The Program was associated with decline in incidence of (i) any-or-none indicator among MUR quartile 2 hospitals (conditional odds ratio=0.57; 95% confidence interval, 0.38-0.87), and (ii) catheter-associated urinary tract infections among MUR quartile 3 hospitals (conditional odds ratio=0.30; 95% confidence interval, 0.12-0.75) as compared with MUR quartile 1 hospitals. Significant declines in certain HACs were noted in the stratified analysis. The Program was associated with decline in incidence of selected HACs, and this decline was variably greater among hospitals with higher MUR.

P-015 YI Incidence of Hospital Acquired Conditions (HACs) in Patients Admitted with Inflammatory Bowel Disease (IBD)

IBD is common among Western populations and the socioeconomic burden of the disease is significant. In 2008, the Centers for Medicare and Medicaid Services (CMS) selected 10 categories of conditions that were deemed as HACs, ranging from falls to vascular catheter-associated infection. Costs related to HACs are not reimbursed as they are considered to be preventable. The effect of this change in reimbursement on the incidence of HACs among patients hospitalized with IBD is unknown. This was a cross-sectional study using data from the Nationwide Inpatient Sample (NIS, 2007–2011). IBD hospitalizations and HACs were identified using appropriate ICD-9-CM codes. We excluded patients under the age of 19 and those who carried the diagnoses of both UC and CD. We excluded HACs that were related to surgical procedures. The presence of HAC was defined as having at least one qualifying complications as listed by the CMS. HAC incidence in patients with UC or CD was evaluated according to health insurance. All analyses were conducted with SAS, version 9.3, Cary, NC. From 2007 to 2011, there were a total of 347,577 discharges related to CD; of those, 1,222 experienced at least 1 HAC. The overall HAC incidence rate for CD patients was 0.35%. There has been a slow upward trend in the incidence of HACs since 2007 from 0.18% to 0.42% in 2011 (P ≤ 0.0001). This trend was significant in Medicare, Medicaid and private insurance patients alike. HACs disproportionately affected Medicare patients during the time period compared with Medicaid or private patients (incidence 0.74% versus 0.24% or 0.21%, respectively). However, on multivariate analysis, there was no significant difference between the groups. During the time period, there were 188,125 UC discharges with 1,068 patients experiencing HACs and an incidence rate of 0.57%. There was an overall increase in incidence of HACs from 2007 to 2011 (P = 0.0027). UC patients on Medicare had higher rates of HACs compared with Medicaid or private patients (1.25% versus 0.46% and 0.21%, respectively). After adjusting for confounders, the odds ratio for experiencing HACs was 2.91 for Medicare patients and 2.56 for Medicaid patients, compared with private insurance holders (P < 0.0001). There was no appreciable decline in the incidence of HACs across U.S. hospitals in the years following implementation of the CMS non-reimbursement policies. In fact, there has been increased reporting of HAC occurrences over the examined period. IBD, especially UC, patients on Medicare have the highest risk of experiencing a hospital-acquired complication, which may be related to older age. Heightened awareness is required to understand and address this disparity.

Association Between Opioid Abuse/Dependence and Outcomes in Hospitalized Heart Failure Patients.

Opioid use is associated with unintentional and intentional overdose and is one of the leading causes of emergency room visits and accidental deaths. However, the association between opioid abuse/dependence and outcomes in hospitalized patients has not been well studied. Congestive heart failure (HF) is the fourth most common cause of hospitalization in the United States. The purpose of this study was to examine the effect of opioid abuse/dependence on outcomes in patients hospitalized with HF. We queried the 2002-2010 Nationwide Inpatient Sample databases to identify all patients aged 18 years and older admitted with the primary diagnosis of HF. Multivariate logistic regression analysis was used to compare the frequency of hospital-acquired conditions (HACs) and in-hospital mortality between patients with and without a history of opioid abuse/dependence. Of 9,993,240 patients with HF, 29,014 had a history of opioid abuse or dependence. Opioid abusers/dependents were likely to be younger men of poor socioeconomic background with self pay or Medicaid as their primary payer. They had a lower prevalence of dyslipidemia, diabetes mellitus, coronary artery disease, prior myocardial infarction, and peripheral vascular disease (P < 0.001 for all). They were more likely to be smokers and have chronic pulmonary disease, depression, liver disease, and obesity (P < 0.001 for all). Patients with a history of opioid abuse/dependence had lower incidence of HACs (14.8% vs. 16.5%, adjusted odds ratio: 0.71, P < 0.001) and lower in-hospital mortality (1.3% vs. 3.6%, adjusted odds ratio: 0.64, P < 0.001) as compared with patients without prior opioid abuse/dependence. In conclusion, among adult patients aged 18 years and older hospitalized with HF, opioid abuse/dependence was associated with lower frequency of HACs and lower in-hospital mortality.

Abstract WP316: Incidence, Risk Factors, and In-Hospital Outcomes Associated With Hospital-Acquired Conditions and Patient Safety Indicators In Spontaneous Intracerebral Hemorrhage

Introduction: The Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) and the Agency for Healthcare Research and Quality patient safety indicators (PSIs) are standardized quality metrics linked to reimbursement. Spontaneous intracerebral hemorrhage (ICH) is associated with a poorer prognosis than other types of stroke. The incidence, risk factors, and in-hospital outcomes associated with HACs and PSIs in ICH admissions have not previously been reported. Methods: The Nationwide Inpatient Sample was queried from 2002 to 2011 to identify all ICH patients (ICD-9-CM code 431). The incidence of HACs and PSIs was determined. Multivariable logistic regression analyzed the effect of patient and hospital factors on HAC/PSI occurrence and the effect of HAC/PSI occurrence on prolonged length of stay (defined as ≥ 75th percentile), increased hospital costs (defined as ≥75th percentile), and adverse discharge (except routine). Results: A total of 12,870 HACs and 260,048 PSIs were identified among 643,660 hospitalizations for spontaneous ICH. The HACs with the highest incidence were falls/trauma (n=1,198), postoperative poor glycemic control (n=895), stage III/IV pressure ulcers (n=622), and iatrogenic pneumothorax (n=620). The PSIs with the highest incidence were postoperative respiratory failure (n=194,859), postoperative sepsis (n=19,045), pressure ulcer (n=17,826), and deep vein thrombosis (n=15,759). Comorbidity score (19.7%, 18.9% increase per comorbidity, p&lt;0.0001) and Medicaid insurance (31.5%, 21.4%, p&lt;0.0001) were independent predictors of HAC and PSI occurrence, respectively. Black race (15.7%, p&lt;0.0001), urban hospitals (69%, p&lt;0.0001), and teaching hospitals (35.2%, p&lt;0.0001) were independent predictors of PSI occurrence only. Both HAC and PSI occurrence increased the odds of prolonged LOS (64.9%, 36.9%, p&lt;0.0001), increased hospital costs (70.8%, 72.9%, p&lt;0.0001) and adverse discharge (32%, 167.1%, p&lt;0.0001). Conclusion: HACs and PSIs occur frequently in ICH hospitalizations and are associated with poor in-hospital outcomes. Awareness of the factors that increase the likelihood of incurring HACs and PSIs may contribute to new quality protocols targeted at these factors.

Medicare’s Hospital-Acquired Conditions Policy: A Problem of Nonpayment After Total Joint Arthroplasty

BackgroundTotal joint arthroplasty (TJA) utilization continues to increase, and optimizing efficiency while reducing complications is critical to provide a sustainable product. Recent policy has defined several hospital-acquired conditions (HACs) that are the target of reducing complications with significant financial implications. The present study defines the incidence of HACs after TJA as well as patient and hospital factors associated with HACs. MethodsThe National Inpatient Sample (NIS) was used to identify all patients from 2009 to 2011 undergoing elective total hip or knee arthroplasty. Patient demographics, comorbidities, and hospital characteristics were obtained from the database, and HACs defined according to established International Classification of Diseases, Ninth Revision, Clinical Modification criteria. The incidence of HACs after TJA was calculated, as were demographic factors and preadmission comorbidities associated with HACs using bivariate and multivariable analysis. ResultsThe overall incidence of HACs after TJA was 1.3%. Several patient and hospital factors, including increased age, female gender, black race, medium hospital bed size, year of surgery, and Charlson Comorbidity Index ≥1, independently predicted development of a HAC. When evaluating the financial impact of the development of a HAC after TJA, more than 200 million dollars in hospital costs would be lost during the inclusive years of this study, equating to nearly 70 million dollars annually. ConclusionThe incidence of HACs after TJA is 1.3%. Many of the patient factors associated with HACs are nonmodifiable, and risk adjustment should be considered to provide a sustainable product to a diverse patient population.

ED-08 * INSURANCE STATUS INFLUENCES THE RATES OF REPORTABLE QUALITY METRICS IN BRAIN TUMOR PATIENTS: A NATIONWIDE INPATIENT SAMPLE STUDY

INTRODUCTION: The Patient Protection and Affordable Care Act was passed to narrow disparities and improve the quality of health care in the United States. The Agency for Healthcare Research and Quality patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are quality metrics tracked in healthcare institutions. The effects of insurance status on PSIs and HACs were analyzed using the Nationwide Inpatient Sample (NIS) database for brain tumor patients. METHODS: The NIS was queried for hospitalizations between 2002 and 2011 involving brain tumors patients. The incidence for each PSI and HAC was determined by ICD-9 codes. The independent variable was primary payer status. Because of the age restriction with Medicare, comparisons were made between Medicaid/self-pay and private insurance. Logistic regression modeling was used to estimate the effects of insurance status on individual PSIs, HACs, and patient outcomes. RESULTS: Overall, 113,797 PSIs and 15,810 HACs occurred in 548,727 brain tumor patients, an estimated national incidence of 20.7% and 2.9% respectively. Medicaid/self-pay patients had a higher PSI incidence compared to private insurance patients (20.6% versus 18.6%). Medicaid/self-pay patients also had a higher incidence of HACs (2.2% versus 1.9%). After controlling for patient and hospital factors, Medicaid/self-pay patients were estimated to experience 3.6% more PSIs per patient than private insurance (p = 0.0042). In addition, Medicaid/self-pay patients were eistamted to experience 12.6% more HACs per patient (p = 0.0001). The greater incidence of PSIs and HACs correlated with increased length of stay and worse discharge outcomes and in-hospital mortality in the Medicaid/self-pay patient population. CONCLUSIONS: Significant variability exists in the incidence of PSIs and HACs in brain tumor patients based on insurance status. The cause of these differences should be studied prospectively to begin the process of improving quality metrics in vulnerable patient populations.

123 Establishing Standard Performance Measures in Adult Traumatic Brain Injury Patients

INTRODUCTION:: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are publicly reported metrics that illustrate the overall quality of care of an institution. The incidences of PSIs and HACs in traumatic brain injury (TBI) patients were determined using the nationwide inpatient sample (NIS) database. METHODS:: The NIS database was queried for patients admitted with International Classification of Diseases, Ninth Revision diagnosis codes consistent with TBI. The incidences of PSIs and HACs were determined for TBI patients and compared between teaching and non-teaching hospitals. A logistic regression model was created to estimate the effects of insurance status on PSIs, HACs, and patient outcomes. RESULTS:: There were 15 403 total PSIs among 24 012 TBI patients. Teaching hospitals had a higher incidence of PSIs (653 per 1000 patients) compared to non-teaching hospitals (615 per 1000 patients; P =.0016) as well as a higher fraction of patients suffering at least 1 PSI (54.0% vs 50.8%; P =.004). There were only 165 HACs among 24 012 TBI patients. There was no significant difference between teaching and non-teaching hospitals in incidence of HACs; HACs were more common, however, in Medicaid patients compared to privately insured patients (8.9 vs 5.0 HACs/1000 patients; P =.0015.) Multivariate analyses comparing the Medicaid and private insurance patients demonstrated no difference between the groups in either poor outcome or mortality; however, the length of stay for Medicaid patients was prolonged 2.0 days compared with private insurance (95% CI: [1.35, 2.62]; P CONCLUSION:: Clinical outcomes following TBI were not affected by insurance status. Patients treated in teaching hospitals suffered a higher incidence of PSIs, although this was not controlled for injury severity. These data may be used as reference values for hospitals reporting their own rates and seeking to improve the quality of care they provide for TBI patients. Language: en

Incidence, Cost, and Mortality Associated With Hospital-Acquired Conditions After Resection of Cranial Neoplasms

In 2007, the Centers for Medicare and Medicaid Services stopped reimbursing for treatment of specified hospital-acquired conditions (HACs), also known as "never events." To establish benchmarks for HACs after common neurosurgical oncologic procedures. We identified adults in the Nationwide Inpatient Sample between 2002 and 2009 who underwent resection of a benign or malignant brain tumor. Baseline demographics, medical comorbidities, and hospital-level variables were assessed. A generalized estimating equation, multivariable-logistic model was used to identify predictors of HACs, mortality, prolonged hospital length of stay, and increased hospital charges. We identified 310,133 patients undergoing surgical treatment of a cranial neoplasm; 5.4% experienced an HAC. More medical comorbidities and the presence of an immediate postoperative neurosurgical complication increased one's risk of having an HAC (odds ratios: 1.56 and 2.48, respectively; both P < .01). Patients who experienced an HAC faced increased in-hospital mortality (6.47% vs 1.53%; P < .01) and increased total hospital costs ($52,882.61 vs $25,569.45; P < .01). Patients at urban teaching hospitals and those with a high surgical volume were more likely to experience an HAC compared with those treated at rural nonteaching hospitals and those with a low surgical volume (odds ratios: 1.33 and 1.16, respectively; P < .01). We found a 5.4% incidence of HACs after neurosurgical oncologic procedures, which varied based on several patient and hospital-level factors. A thorough analysis of the relationship between patient, procedure, and HAC incidence will be important to developing fair compensation practices for physicians as well as payers. Additionally, further investigation may identify opportunities for future quality improvement initiatives.

Hospital‐acquired conditions in head and neck cancer surgery

The Centers for Medicare and Medicaid Services has identified 10 hospital-acquired conditions (HACs) for which they will not reimburse care. We sought to determine the incidence of HACs in head and neck cancer (HNCA) surgery and the association with in-hospital mortality, complications, length of hospitalization, and costs. Retrospective cross-sectional study. Discharge data from the Nationwide Inpatient Sample for 123,662 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm during 2001-2008 were analyzed using cross-tabulations and multivariate regression modeling. HACs occurred in <1% of cases, with vascular catheter-associated infection comprising >70% of all HACs. The occurrence of HACs was significantly associated with urgent or emergent admission (odds ratio [OR]=2.0, P=.004), major surgical procedures (OR=2.3, P<.001), flap reconstruction (OR=3.5, P<.001), and advanced comorbidity (OR=2.0, P<.001). There was no association between HACs and hospital size, location, ownership, volume status, or safety-net burden. HACs were significantly associated with in-hospital mortality (OR=3.8, P=.001), surgical complications (OR=4.9, P<.001), and medical complications (OR=5.6, P<.001). After controlling for all other variables, HACs were associated with significantly increased length of hospitalization and hospital-related costs, with vascular catheter-associated infection and foreign object after surgery associated with the greatest increase in length of stay and costs. HACs are uncommon events in HNCA surgical patients. Because prediction of HACs is poor and the potential for human error crosses demographic, geographic, and structural boundaries, universal innovative measures to reduce the occurrence of HACs are needed.