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Hospital variation in postoperative infection and outcome after congenital heart surgery.

Publication ,  Journal Article
Pasquali, SK; He, X; Jacobs, ML; Hall, M; Gaynor, JW; Shah, SS; Peterson, ED; Hill, KD; Li, JS; Jacobs, JP
Published in: Ann Thorac Surg
August 2013

BACKGROUND: Several initiatives aim to reduce postoperative infection across a variety of surgical patients as a means to improve overall quality of care and reduce variation across centers. However, the association of infection rates with hospital-level outcomes and resource utilization has not been well described. We evaluated this association across a multicenter cohort undergoing congenital heart surgery. METHODS: The Society of Thoracic Surgeons Congenital Heart Surgery Database was linked to resource utilization data from the Pediatric Health Information Systems Database for hospitals participating in both (2006 to 2010). Hospital-level infection rates (sepsis, wound infection, mediastinitis, endocarditis, pneumonia) adjusted for patient risk factors and case mix were calculated using Bayesian methodology, and association with hospital mortality rates, postoperative length of stay (LOS), and total costs evaluated. RESULTS: The cohort included 32,856 patients (28 centers); 3.7% had a postoperative infection. Across hospitals, the adjusted infection rate varied from 0.9% to 9.8%. Hospitals with the highest infection rates had longer (LOS) (13.2 vs 11.7 days, p < 0.001) and increased hospital costs ($71,100 vs $65,100, p < 0.001), but similar mortality rates (odds ratio 0.99, 95% confidence interval 0.80 to 1.21, p = 0.9). The proportion of variation in costs and LOS explained by infection was 15% and 6%, respectively. CONCLUSIONS: Infection after congenital heart surgery contributes to prolonged LOS and increased costs on a hospital level. However, given that infection rates alone explained relatively little of the variation in these outcomes across hospitals, further study is needed to identify additional factors that may be targeted in initiatives to reduce variation and improve outcomes across centers.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

August 2013

Volume

96

Issue

2

Start / End Page

657 / 663

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Respiratory System
  • Postoperative Complications
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Heart Defects, Congenital
  • Female
  • Cross Infection
 

Citation

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ICMJE
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Pasquali, S. K., He, X., Jacobs, M. L., Hall, M., Gaynor, J. W., Shah, S. S., … Jacobs, J. P. (2013). Hospital variation in postoperative infection and outcome after congenital heart surgery. Ann Thorac Surg, 96(2), 657–663. https://doi.org/10.1016/j.athoracsur.2013.04.024
Pasquali, Sara K., Xia He, Marshall L. Jacobs, Matthew Hall, J William Gaynor, Samir S. Shah, Eric D. Peterson, Kevin D. Hill, Jennifer S. Li, and Jeffrey P. Jacobs. “Hospital variation in postoperative infection and outcome after congenital heart surgery.Ann Thorac Surg 96, no. 2 (August 2013): 657–63. https://doi.org/10.1016/j.athoracsur.2013.04.024.
Pasquali SK, He X, Jacobs ML, Hall M, Gaynor JW, Shah SS, et al. Hospital variation in postoperative infection and outcome after congenital heart surgery. Ann Thorac Surg. 2013 Aug;96(2):657–63.
Pasquali, Sara K., et al. “Hospital variation in postoperative infection and outcome after congenital heart surgery.Ann Thorac Surg, vol. 96, no. 2, Aug. 2013, pp. 657–63. Pubmed, doi:10.1016/j.athoracsur.2013.04.024.
Pasquali SK, He X, Jacobs ML, Hall M, Gaynor JW, Shah SS, Peterson ED, Hill KD, Li JS, Jacobs JP. Hospital variation in postoperative infection and outcome after congenital heart surgery. Ann Thorac Surg. 2013 Aug;96(2):657–663.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

August 2013

Volume

96

Issue

2

Start / End Page

657 / 663

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Respiratory System
  • Postoperative Complications
  • Male
  • Infant, Newborn
  • Infant
  • Humans
  • Heart Defects, Congenital
  • Female
  • Cross Infection