Impact of hospital-acquired conditions on financial liabilities for Medicare patients

Coomer, Nicole; Kandilov, Amy

doi:10.1016/j.ajic.2016.03.025

Cited by 21 publications

(22 citation statements)

References 29 publications

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“…Surgical‐site infection (SSI) is the most frequent type of nosocomial infection among surgical patients. SSIs significantly increase duration of hospital stay, ICU admission, long‐term surgical‐site complication rate, patient suffering, antibiotic use, costs and mortality. The risk of SSI varies according to the type of surgery.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Svensson‐Björk

Zarrouk

Asciutto

et al. 2019

British Journal of Surgery

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Background: Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery.Methods: A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool.Results: Among 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0⋅35, 95 per cent c.i. 0⋅24 to 0⋅50; P < 0⋅001). The heterogeneity between the included studies was low (I 2 = 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0⋅37, 0⋅22 to 0⋅63; P < 0⋅001; I 2 = 0 per cent).Conclusion: Incisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.

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Section: Introductionmentioning

confidence: 99%

Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Svensson‐Björk

Zarrouk

Asciutto

et al. 2019

British Journal of Surgery

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“…[1] SSIs altogether increment the length of hospital stay, morbidity, and mortality and along these lines deplete medicinal services framework assets. [2] Proper utilization of anti-infection agents can decrease the occurrence of SSI,[3] and the unsuitable use of antibiotics for prophylaxis increased drug toxicity and the emergence of antibiotic-resistant bacteria. [3]…”

Section: Introductionmentioning

confidence: 99%

An audit of perioperative antimicrobial prophylaxis: Compliance with the international guidelines

2017

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Objective:Antimicrobial prophylaxis has been demonstrated to lower the incidence of postoperative infection in nearly all types of surgery. The American Society of Health-System Pharmacists (ASHP) guideline summarizes current data on the appropriate use of antibiotic for surgical prophylaxis. The objective of this study was to assess and audit the use of antibiotics in a tertiary care center according to the recommendation of ASHP guideline.Methods:This cross-sectional study was performed using prospective data gathered from April to September 2015 in the surgical wards of Al Zahra Hospital, Isfahan, Iran. Antibiotic indication and choice, dose, dosing interval, route of administration, and timing of first administration and duration of prophylaxis were compared with the ASHP guideline recommendations.Findings:A total of 100 patients with the mean age of 49.8 ± 18.2 years were recruited for this study. About 22% of procedures had full compliance with all guideline recommendations. The most frequently encounter noncompliance type were the duration of prophylaxis (14%) and appropriate agent choice (35%). Timing of the initial dose was appropriate in most of the procedures (42%).Conclusion:This study revealed that most of the prescribed antibiotics for surgical prophylaxis are not in accordance with standard treatment guideline. The density of antimicrobial use for preoperative antimicrobial prophylaxis is very high. Furthermore, the hospital should develop a formal strategy, including a local guideline for antimicrobial prophylaxis in surgical procedures.

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“…Most of these costs have been shifted to the hospitals, but patients bear additional liability when factoring for deductibles, co-payments and coinsurance and the additional length of stay needed to treat this condition [5].…”

Section: Introductionmentioning

confidence: 99%

Investigating the potential for machine learning prediction of patient outcomes: a retrospective study of hospital acquired pressure injuries

Levy

Lima

Miller

et al. 2020

Preprint

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Background: While recent research efforts to reduce pressure ulcers in the clinical context have focused on key retrospective characteristics, little work has focused on creating real-time predictive models to prevent this avoidable hospital-acquired injury. Furthermore, existing machine learning heuristics often fail to surpass traditional statistical models or provide individual-level risk assessments with explanations for each patient. Thus, we sought to compare the predictive performance of five machine learning and traditional statistical modeling techniques to predict the occurrence of Hospital Acquired Pressure Injuries (HAPI). Methods: Electronic Medical Record (EMR) information was collected from 57,227 hospitalizations, containing 241 positive HAPI cases, acquired from Dartmouth Hitchcock Medical Center from April 2011 to December 2016. The five classifiers were trained to predict HAPI incidence and performance was assessed using the C-statistic or Area Under the Receiver Operating Curve (AUC). Results: Logistic Regression was the best modeling approach (AUC=0.91 ± 0.034). We report discordance between predictors deemed important by the machine learning models compared to traditional statistical model. We provide means to visually assess factors important to every patient's prediction, regardless of the modeling approach, through Shapley Additive Explanations. Conclusions: Machine learning models will continue to inform decision making processes but should be compared to traditional modeling approaches to ensure proper utilization. Disagreements between important predictors found by traditional and machine learning modeling approaches can potentially confuse clinicians and as such need to be reconciled. Future efforts to analyze time-stamped, prospective medical record data will be enhanced by patient-specific details. These developments represent important steps forward in developing real-time predictive models that can be integrated and readily deployed in electronic medical record systems to reduce unnecessary harm.

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Impact of hospital-acquired conditions on financial liabilities for Medicare patients

Cited by 21 publications

References 29 publications

Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

An audit of perioperative antimicrobial prophylaxis: Compliance with the international guidelines

Investigating the potential for machine learning prediction of patient outcomes: a retrospective study of hospital acquired pressure injuries

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