Financial impact of surgical site infections on hospitals: The hospital management perspective

John Shepard, William Ward, Aaron Milstone, Taylor Carlson, John Frederick, Eric Hadhazy, Trish Perl

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

IMPORTANCE Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators. OBJECTIVE To determine the change in hospital profit due to SSIs. DESIGN Retrospective study of data from January 1, 2007, to December 31, 2010. SETTING The study was performed at 4 of The Johns Hopkins Health System acute care hospitals in Maryland: Johns Hopkins Bayview (560 beds); Howard County General Hospital (238 beds); The Johns Hopkins Hospital (946 beds); and Suburban Hospital (229 beds). PARTICIPANTS Eligible patients for the study included those patients admitted to the 4 hospitals between January 1, 2007, and December 31, 2010, with complete data and the correct International Classification of Diseases, Ninth Revision code, as determined by the infection preventionist. Infection preventionists performed complete medical record review using National Healthcare Safety Network definitions to identify SSIs. Patients were stratified using the All Patient Refined Diagnosis Related Groups to estimate the change in hospital profit due to SSIs. EXPOSURE Surgical site infections. MAIN OUTCOMES AND MEASURES The outcomes of the study were the difference in daily total charges, length of stay (LOS), 30-day readmission rate, and profit for patients with an SSI when compared with patients without an SSI. The hypothesis, formulated prior to data collection, that patients with an SSI have higher daily total costs, a longer LOS, and higher 30-day readmission rates than patients without an SSI, was tested using a nonpaired Mann-Whitney U test, an analysis of covariance, and a Pearson ?2 test. Hospital charges were used as a proxy for hospital cost. RESULTS The daily total charges, mean LOS, and 30-day readmission rate for patients with an SSI compared with patients without an SSI were $7493 vs $7924 (P = .99); 10.56 days vs 5.64 days (P < .001); and 51.94 vs 8.19 readmissions per 100 procedures (P < .001). The change in profit due SSIs was $2 268 589. CONCLUSIONS AND RELEVANCE The data suggest that hospitals have a financial incentive to reduce SSIs, but hospitals should expect to see an increase in both cost and revenue when SSIs are reduced.

Original languageEnglish (US)
Pages (from-to)907-914
Number of pages8
JournalJAMA Surgery
Volume148
Issue number10
DOIs
StatePublished - Oct 1 2013

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Surgical Wound Infection
Patient Readmission
Length of Stay
Hospital Administrators
Hospital Charges
County Hospitals
Costs and Cost Analysis
Hospital Costs
Diagnosis-Related Groups
Proxy
International Classification of Diseases
Nonparametric Statistics
Infection
General Hospitals
Health Care Costs

ASJC Scopus subject areas

  • Surgery

Cite this

Shepard, J., Ward, W., Milstone, A., Carlson, T., Frederick, J., Hadhazy, E., & Perl, T. (2013). Financial impact of surgical site infections on hospitals: The hospital management perspective. JAMA Surgery, 148(10), 907-914. https://doi.org/10.1001/jamasurg.2013.2246

Financial impact of surgical site infections on hospitals : The hospital management perspective. / Shepard, John; Ward, William; Milstone, Aaron; Carlson, Taylor; Frederick, John; Hadhazy, Eric; Perl, Trish.

In: JAMA Surgery, Vol. 148, No. 10, 01.10.2013, p. 907-914.

Research output: Contribution to journalArticle

Shepard, J, Ward, W, Milstone, A, Carlson, T, Frederick, J, Hadhazy, E & Perl, T 2013, 'Financial impact of surgical site infections on hospitals: The hospital management perspective', JAMA Surgery, vol. 148, no. 10, pp. 907-914. https://doi.org/10.1001/jamasurg.2013.2246
Shepard J, Ward W, Milstone A, Carlson T, Frederick J, Hadhazy E et al. Financial impact of surgical site infections on hospitals: The hospital management perspective. JAMA Surgery. 2013 Oct 1;148(10):907-914. https://doi.org/10.1001/jamasurg.2013.2246
Shepard, John ; Ward, William ; Milstone, Aaron ; Carlson, Taylor ; Frederick, John ; Hadhazy, Eric ; Perl, Trish. / Financial impact of surgical site infections on hospitals : The hospital management perspective. In: JAMA Surgery. 2013 ; Vol. 148, No. 10. pp. 907-914.
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abstract = "IMPORTANCE Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators. OBJECTIVE To determine the change in hospital profit due to SSIs. DESIGN Retrospective study of data from January 1, 2007, to December 31, 2010. SETTING The study was performed at 4 of The Johns Hopkins Health System acute care hospitals in Maryland: Johns Hopkins Bayview (560 beds); Howard County General Hospital (238 beds); The Johns Hopkins Hospital (946 beds); and Suburban Hospital (229 beds). PARTICIPANTS Eligible patients for the study included those patients admitted to the 4 hospitals between January 1, 2007, and December 31, 2010, with complete data and the correct International Classification of Diseases, Ninth Revision code, as determined by the infection preventionist. Infection preventionists performed complete medical record review using National Healthcare Safety Network definitions to identify SSIs. Patients were stratified using the All Patient Refined Diagnosis Related Groups to estimate the change in hospital profit due to SSIs. EXPOSURE Surgical site infections. MAIN OUTCOMES AND MEASURES The outcomes of the study were the difference in daily total charges, length of stay (LOS), 30-day readmission rate, and profit for patients with an SSI when compared with patients without an SSI. The hypothesis, formulated prior to data collection, that patients with an SSI have higher daily total costs, a longer LOS, and higher 30-day readmission rates than patients without an SSI, was tested using a nonpaired Mann-Whitney U test, an analysis of covariance, and a Pearson ?2 test. Hospital charges were used as a proxy for hospital cost. RESULTS The daily total charges, mean LOS, and 30-day readmission rate for patients with an SSI compared with patients without an SSI were $7493 vs $7924 (P = .99); 10.56 days vs 5.64 days (P < .001); and 51.94 vs 8.19 readmissions per 100 procedures (P < .001). The change in profit due SSIs was $2 268 589. CONCLUSIONS AND RELEVANCE The data suggest that hospitals have a financial incentive to reduce SSIs, but hospitals should expect to see an increase in both cost and revenue when SSIs are reduced.",
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