Impact of Postoperative Infections on Readmission and Resource Use in Elective Cardiac Surgery

Hadaya, Joseph; Downey, Peter; Tran, Zachary; Sanaiha, Yas; Verma, Arjun; Shemin, Richard J.; Benharash, Peyman

doi:10.1016/j.athoracsur.2021.04.013

Cited by 18 publications

(20 citation statements)

References 32 publications

(30 reference statements)

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“…A number of studies [ 6 , 12 , 97 – 99 ] have analyzed the cost aspects of NECI; the increased utilization of specific hospital resources prolongs the hospitalization time also because of the occurrence of other noninfectious complications and raises the problem of the readmissions. It is estimated that NECI increase the hospitalization time up to about 2 weeks with a cost increase by about 60% [ 12 ].…”

Section: Costsmentioning

confidence: 99%

“…Narrowing our research, we are only discussing here the nosocomial extracardiac infections (NECI), which are all those not affecting the heart and whose onset is within two months from cardiac surgery intervention. These represent a major public health issue for a number of reasons: excess mortality (odds ratio 4.02), long-term hospitalization, greater risk of rehospitalization, and cost increase [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Nosocomial Extracardiac Infections After Cardiac Surgery

Zardi

Chello

Zardi³

et al. 2022

Curr Infect Dis Rep

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Purpose of Review Nosocomial extracardiac infections after cardiac surgery are a major public health issue affecting 3–8.2% of patients within 30–60 days following the intervention. Recent Findings Here, we have considered the most important postoperative infective complications that, in order of frequency, are pneumonia, surgical site infection, urinary tract infection, and bloodstream infection. The overall picture that emerges shows that they cause a greater perioperative morbidity and mortality with a longer hospitalization time and excess costs. Preventive interventions and corrective measures, diminishing the burden of nosocomial extracardiac infections, may reduce the global costs. A multidisciplinary team may assure a more appropriate management of nosocomial extracardiac infections leading to a reduction of hospitalization time and mortality rate. Summary The main and most current data on epidemiology, prevention, microbiology, diagnosis, and management for each one of the most important postoperative infective complications are reported. The establishment of an antimicrobial stewardship in each hospital seems to be, at the moment, the more valid strategy to counteract the challenging problems.

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Section: Costsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nosocomial Extracardiac Infections After Cardiac Surgery

Zardi

Chello

Zardi³

et al. 2022

Curr Infect Dis Rep

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“…Each hospital's O/E for costs and quality was then calculated from the estimates aggregated at the hospital-level, and 95% confidence intervals were generated from 1000 bootstrap iterations. 19,20 To quantify the variation attributable to hospital factors, we created 2 multilevel mixed effects models. We quantified the variation in costs and adverse outcomes across hospitals using the intraclass correlation ¼ observed-to-expected ratio coefficient (ICC), comparing the ICC for each of the models.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Defining value in cardiac surgery: A contemporary analysis of cost variation across the United States

et al. 2022

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“…Furthermore, patients with LC have been shown to experience delayed hospital discharge, greater in-hospital resource use, and reduced quality of life [ 12 , 15 , 16 ]. Thus, several clinical methods have been devised to screen and diagnose these conditions with fiberoptic endoscopic evaluation of swallowing (FEES) being the most common, as it can assess both swallow and vocal fold mobility in a reliable fashion [ 17 , 18 ]. However, a universally adopted screening tool for post-surgical dysphonia and dysphagia remains lacking [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Outcomes of Laryngeal Complications Following Adult Cardiac Surgery: A National Analysis

et al. 2021

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Laryngeal complications (LCs) following cardiac operations contribute to increased morbidity and resource utilization. Using a nationally representative cohort of cardiac surgical patients, we characterized the incidence of LC as well as its associated clinical and financial outcomes. All adults undergoing coronary artery bypass grafting and/or valvular operations were identified using the 2010–2017 Nationwide Readmissions Database. International Classification of Diseases 9th and 10th Revision diagnosis codes were used to identify LC. Trends were analyzed using a rank-based, non-parametric test (nptrend). Multivariable linear and logistic regressions were used to evaluate risk factors for LC, and its impact on mortality, complications, resource use and 30-day non-elective readmissions. Of an estimated 2,319,628 patients, 1.7% were diagnosed with perioperative LC, with rising incidence from 1.5% in 2010 to 1.8% in 2017 (nptrend < 0.001). After adjustment, female sex [adjusted odds ratio 1.08, 95% confidence interval (CI) 1.04–1.12], advancing age, and multi-valve procedures (1.51, 95% CI 1.36–1.67, reference: isolated CABG) were associated with increased odds of LC. Despite no risk-adjusted effect on mortality, LC was associated with increased odds of pneumonia (2.88, 95% CI 2.72–3.04), tracheostomy (4.84, 95% CI 4.44–5.26), and readmission (1.32, 95% CI 1.26–1.39). In addition, LC was associated with a 7.7-day increment (95% CI 7.4–8.0) in hospitalization duration and $24,200 (95% CI 23,000–25,400) in attributable costs. The present study found LC to be associated with increased perioperative sequelae and resource utilization. The development and application of active screening protocols for post-surgical LC are warranted to increase early detection and reduce associated morbidity.

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Impact of Postoperative Infections on Readmission and Resource Use in Elective Cardiac Surgery

Cited by 18 publications

References 32 publications

Nosocomial Extracardiac Infections After Cardiac Surgery

Nosocomial Extracardiac Infections After Cardiac Surgery

Defining value in cardiac surgery: A contemporary analysis of cost variation across the United States

Incidence and Outcomes of Laryngeal Complications Following Adult Cardiac Surgery: A National Analysis

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