Patient characteristics and the occurrence of never events.

Michael Pine and Associates, 5020 S. Lake Shore Drive, Chicago, IL 60615, USA.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.3). 02/2010; 145(2):148-51. DOI: 10.1001/archsurg.2009.277
Source: PubMed

ABSTRACT To determine whether the occurrence of "never events" after major surgical procedures is affected by patient and disease characteristics and by the type of operation performed.
Epidemiological analysis.
Derivation and assessment of predictive equations for postoperative infectious events and decubitus ulcers using Healthcare Cost and Utilization Project Nationwide Inpatient Sample administrative claims data for patients hospitalized between 2002 and 2005.
C statistics for each predictive equation with and without hospital dummy variables.
Predictive equations for 6 of 8 complications had C statistics greater than 0.65 without hospital variables, while 2 had C statistics of less than 0.55. All equations had C statistics greater than 0.75 when hospital dummy variables were included.
Patient characteristics and type of operative procedure are important predictors of complications of surgical care evaluated in this study, undermining the rationale for their current classification as "never events." Variations in risk-adjusted complication rates among hospitals support the influence of quality of care on their occurrence. Development and use of warranties to cover costs associated with caring for the unavoidable components of potentially avoidable complications is proposed as a means of rewarding high-quality providers without creating unrealistic expectations or perverse financial incentives.

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    Journal of Parenteral and Enteral Nutrition 09/2014; 38. DOI:10.1177/0148607114549769
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    Nutrients 01/2016; 6(12):6076-6094. DOI:10.3390/nu6126076
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    ABSTRACT: Background:Undernutrition status at hospital admission is related to increased hospital costs. Handgrip strength (HGS) is an indicator of undernutrition, but the ability of HGS to predict hospitalization costs has yet to be studied.Objective:To explore whether HGS measurement at hospital admission can predict patient's hospitalization costs.Subjects/Methods:A prospective study was conducted in a university hospital. Inpatient's (n=637) HGS and undernutrition status by Patient-Generated Subjective Global Assessment were ascertained. Multivariable linear regression analysis, computing HGS quartiles by sex (reference: fourth quartile, highest), was conducted in order to identify the independent predictors of hospitalization costs. Costs were evaluated through percentage deviation from the mean cost, after adjustment for patients' characteristics, disease severity and undernutrition status.Results:Being in the first or second HGS quartiles at hospital admission increased patient's hospitalization costs, respectively, by 17.5% (95% confidence interval: 2.7-32.3) and 21.4% (7.5-35.3), which translated into an increase from [euro ]375 (58-692) to [euro ]458 (161-756). After the additional adjustment for undernutrition status, being in the first or second HGS quartiles had, respectively, an economic impact of 16.6% (1.9-31.2) and 20.0% (6.2-33.8), corresponding to an increase in hospitalization expenditure from [euro ]356 (41-668) to [euro ]428 (133-724).Conclusions:Low HGS at hospital admission is associated with increased hospitalization costs of between 16.6 and 20.0% after controlling for possible confounders, including undernutrition status. HGS is an inexpensive, noninvasive and easy-to-use method that has clinical potential to predict hospitalization costs.European Journal of Clinical Nutrition advance online publication, 5 November 2014; doi:10.1038/ejcn.2014.242.
    European Journal of Clinical Nutrition 11/2014; 69(2). DOI:10.1038/ejcn.2014.242

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