PMID- 37880706 OWN - NLM STAT- MEDLINE DCOM- 20231027 LR - 20231122 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 23 IP - 1 DP - 2023 Oct 25 TI - Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study. PG - 1150 LID - 10.1186/s12913-023-10055-z [doi] LID - 1150 AB - BACKGROUND: The incremental hospital cost and length of stay (LOS) associated with adverse events (AEs) has not been well characterized for planned and unplanned inpatient spine, hip, and knee surgeries. METHODS: Retrospective cohort study of hip, knee, and spine surgeries at an academic hospital in 2011-2012. Adverse events were prospectively collected for 3,063 inpatient cases using the Orthopaedic Surgical AdVerse Event Severity (OrthoSAVES) reporting tool. Case costs were retrospectively obtained and inflated to equivalent 2021 CAD values. Propensity score methodology was used to assess the cost and LOS attributable to AEs, controlling for a variety of patient and procedure factors. RESULTS: The sample was 55% female and average age was 64; 79% of admissions were planned. 30% of cases had one or more AEs (82% had low-severity AEs at worst). The incremental cost and LOS attributable to AEs were $8,500 (95% confidence interval [CI]: 5100-11,800) and 4.7 days (95% CI: 3.4-5.9) per admission. This corresponded to a cumulative $7.8 M (14% of total cohort cost) and 4,290 bed-days (19% of cohort bed-days) attributable to AEs. Incremental estimates varied substantially by (1) admission type (planned: $4,700/2.4 days; unplanned: $20,700/11.5 days), (2) AE severity (low: $4,000/3.1 days; high: $29,500/11.9 days), and (3) anatomical region (spine: $19,800/9 days; hip: $4,900/3.8 days; knee: $1,900/1.5 days). Despite only 21% of admissions being unplanned, adverse events in these admissions cumulatively accounted for 59% of costs and 62% of bed-days attributable to AEs. CONCLUSIONS: This study comprehensively demonstrates the considerable cost and LOS attributable to AEs in orthopaedic and spine admissions. In particular, the incremental cost and LOS attributable to AEs per admission were almost five times as high among unplanned admissions compared to planned admissions. Mitigation strategies focused on unplanned surgeries may result in significant quality improvement and cost savings in the healthcare system. CI - (c) 2023. BioMed Central Ltd., part of Springer Nature. FAU - Rampersaud, Y Raja AU - Rampersaud YR AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. Raja.Rampersaud@uhn.ca. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. Raja.Rampersaud@uhn.ca. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. Raja.Rampersaud@uhn.ca. AD - Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada. Raja.Rampersaud@uhn.ca. FAU - Sundararajan, Kala AU - Sundararajan K AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. FAU - Docter, Shgufta AU - Docter S AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. FAU - Perruccio, Anthony V AU - Perruccio AV AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. AD - Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. FAU - Gandhi, Rajiv AU - Gandhi R AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Adams, Diana AU - Adams D AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. FAU - Briggs, Natasha AU - Briggs N AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. FAU - Davey, J Rod AU - Davey JR AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Fehlings, Michael AU - Fehlings M AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. AD - Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada. FAU - Lewis, Stephen J AU - Lewis SJ AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. AD - Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada. FAU - Magtoto, Rosalie AU - Magtoto R AD - Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada. FAU - Massicotte, Eric AU - Massicotte E AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. AD - Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada. FAU - Sarro, Angela AU - Sarro A AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. AD - Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada. FAU - Syed, Khalid AU - Syed K AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Mahomed, Nizar N AU - Mahomed NN AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Veillette, Christian AU - Veillette C AD - Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. AD - Krembil Research Institute, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. LA - eng GR - STAR-20-0000000012/Arthritis Society/ PT - Journal Article DEP - 20231025 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Humans MH - Female MH - Middle Aged MH - Male MH - Retrospective Studies MH - Length of Stay MH - *Inpatients MH - *Spine/surgery MH - Hospitals PMC - PMC10598977 OTO - NOTNLM OT - Adverse events OT - Complications OT - Economic evaluation OT - Health care costs OT - Inpatient admission OT - Length of stay OT - Neurosurgery OT - Orthopaedic joint surgery OT - Spine surgery COIS- Dr. Y. R. Rampersaud has received royalties from Medtronic and holds investments in Arthur Health Corporation. Dr. N. Mahomed holds investments in Arthur Health Corporation and Arthritis Innovation Corporation. All other authors have no conflicts to disclose. EDAT- 2023/10/26 06:42 MHDA- 2023/10/27 06:42 PMCR- 2023/10/25 CRDT- 2023/10/26 00:01 PHST- 2022/11/03 00:00 [received] PHST- 2023/09/23 00:00 [accepted] PHST- 2023/10/27 06:42 [medline] PHST- 2023/10/26 06:42 [pubmed] PHST- 2023/10/26 00:01 [entrez] PHST- 2023/10/25 00:00 [pmc-release] AID - 10.1186/s12913-023-10055-z [pii] AID - 10055 [pii] AID - 10.1186/s12913-023-10055-z [doi] PST - epublish SO - BMC Health Serv Res. 2023 Oct 25;23(1):1150. doi: 10.1186/s12913-023-10055-z.