Never events after hepatopancreatobiliary operations

Abstract

Background: In 2008, the Centers for Medicare & Medicaid Services (CMS) terminated reimbursement for never events (NE). NE in hepatopancreatobiliary (HPB) patients are poorly understood. We investigated the incidence and effects of NE in this population.

Methods: We queried the Nationwide Inpatient Sample (NIS) to identify all patients who underwent HPB operations, before (Cohort A: 2003-2007) and after (Cohort B: 2008-2011) the CMS mandate. We compared incidence, demographics, outcomes and predictors of NE.

Results: We identified 57,436 HPB patients, of whom 624 (1.1%) incurred a NE. NE occurred more frequently after pancreas (1.4%) than liver (0.9%) and biliary (0.8%) operations (P < .01). The most common NE were falls (43%) and vascular-catheter-associated infections (28%). Paralysis, chronic renal insufficiency, metastatic cancer, altered mental status, weekend admissions and non-elective procedures were correlated with NE. An overall increase in NE was observed between cohorts.

Discussion: HPB surgery patients who sustain NE have significantly worse outcomes, and despite CMS policy changes, NE incidence has not improved. Further efforts to combat NE in HPB surgery patients are necessary to decrease their likelihood.