Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database

Abstract

Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital‐acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital‐acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score‐adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in‐hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30‐, 60‐, and 90‐day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital‐acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.

An economic analysis of a wearable patient sensor for preventing hospital-acquired pressure injuries among the acutely ill patients

“…The study is undepinned by robust clinical evidence from a RCT (Pickham et al, 2018a) and further evidence from a meta-analysis (Nherera 2020). HAPIs are a widely recognised problem, the incremental costs of which has been estimated to be about $21,767, varying by stage of HAPI (Wassel et al, 2020). Any intervetion that reduces the occurance of HAPIs will save the payers and hospitals money, as our study has demonstrated.…”

“…Considering the budget impact of adopting the sensor for a hospital or payer that has a census of 1,000 patients per year, assuming the effectiveness seen in Pickham et al (2018a) study and a baseline rate of HAPIs recorded in the same study of 2.7%, we estimate that the patient-wearable sensor will help prevent 20 HAPIs compared to standard care alone (73% reduction, standard care 27 HAPIs vs. 7 HAPIs for patient-wearable sensor in addition to standard of care). Wassel et al (2020) reported the average additional cost of a HAPI to be $21,767, which varies by HAPI stage. Assuming all the 1,000 patients get the sensor, the hospital can potentially realise a saving of $235,340 per year by adopting this policy.…”

“…Probability of dying was obtained from the US Life Tables (2017), using a 75-year-old with no HAPI in the base case. Wassel et al (2020)…”

“…The cost of treating admitted patients who developed HAPIs and those who did not develop HAPIs was obtained from matched patients admitted in hospital ICU reported in the study by Wassel et al ( 2020), which utilized data from the Premier Healthcare Database (PHD), a US service-level, all-payer database that contains information on medications, laboratory tests performed, diagnostics, and therapeutic services, in statistically de-identified patient daily service records. Wassel et al (2020), assessed the occurrence of HAPIs using ICD-9 codes 707.00-707.09 and 707.20-707.25., and key outcomes included, readmissions, length of hospital stay (LOS) and costs. The total costs by HAPI stage included all services, medications, and supplies billed during the index hospitalization and factored in the patient's LOS including any days of ICU stay.…”

“…Traditional prevention efforts and hospital incentives (Padula et al, 2019) have largely failed to rein in pressure injuries, and HAPIs continue to be expensive to treat. Individual HAPI treatment costs range from roughly $5,000 (Spetz et al, 2013)-over $100,000 (Brem et al, 2010), with most recent data suggesting that the mean cost to treat a HAPI is $21,767 per occurrence (Wassel et al, 2020). These costs increase significantly for critical care patients and for more severe pressure injury stages.…”