Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jan 6;65(1):15-23.
doi: 10.1016/j.jacc.2014.09.079.

Costs associated with health care-associated infections in cardiac surgery

Giampaolo Greco  1 , Wei Shi  2 , Robert E Michler  3 , David O Meltzer  4 , Gorav Ailawadi  5 , Samuel F Hohmann  6 , Vinod H Thourani  7 , Michael Argenziano  8 , John H Alexander  9 , Kathy Sankovic  10 , Lopa Gupta  2 , Eugene H Blackstone  10 , Michael A Acker  11 , Mark J Russo  12 , Albert Lee  13 , Sandra G Burks  5 , Annetine C Gelijns  2 , Emilia Bagiella  2 , Alan J Moskowitz  2 , Timothy J Gardner  14
Affiliations

Costs associated with health care-associated infections in cardiac surgery

Giampaolo Greco et al. J Am Coll Cardiol. .

Abstract

Background: Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited.

Objectives: This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery.

Methods: Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type.

Results: Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs.

Conclusions: Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).

Keywords: health care–associated infection; hospital costs; length of stay.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Distribution of incremental costs by type of resource utilized
The different types of resources were defined by selected revenue code categories.
Central Illustration
Central Illustration. Average cost per day in patients with and without infections
The non-infection group includes all patients from admission until the date of discharge or the date of infection diagnosis. The infection group includes all patients who developed infection from the diagnosis of infection to discharge. The distribution of expenses overtime was derived using the dates of the hospital charges during each hospitalization.
See this image and copyright information in PMC

Comment in

References

    1. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery. 2001;20:1168–75. - PubMed
    1. Fowler VG, Jr, O’Brien SM, Muhlbaier LH, Corey GR, Ferguson TB, Peterson ED. Clinical predictors of major infections after cardiac surgery. Circulation. 2005;112:I358–65. - PubMed
    1. Edwards FH, Ferguson TB. The Society of Thoracic Surgeons Practice Guidelines. Ann Thorac Surg. 2004;77:1140–1. - PubMed
    1. Kollef MH, Sharpless L, Vlasnik J, Pasque C, Murphy D, Fraser VJ. The impact of nosocomial infections on patient outcomes following cardiac surgery. Chest. 1997;112:666–75. - PubMed
    1. Brown PP, Kugelmass AD, Cohen DJ, et al. The frequency and cost of complications associated with coronary artery bypass grafting surgery: results from the United States Medicare program. Ann Thorac Surg. 2008;85:1980–6. - PubMed

Publication types

Associated data