0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Financial Impact of Surgical Site Infections on Hospitals:  The Hospital Management Perspective

John Shepard, MBA1,6; William Ward, MBA2; Aaron Milstone, MD, MHS3,4; Taylor Carlson, BS3; John Frederick, BS3; Eric Hadhazy, MS3; Trish Perl, MD, MSC1,5
[+] Author Affiliations
1Division of Epidemiology and Infection Prevention, The Johns Hopkins Health System, Baltimore, Maryland
2Department of Health Policy and Management, The Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
3Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland
4Division of Infectious Diseases, Department of Pediatrics, The Johns Hopkins School of Medicine, Baltimore, Maryland
5Division of Infectious Diseases, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
6Department of Quality, Patient Safety, and Effectiveness, Stanford Hospital and Clinics, Stanford, California
JAMA Surg. 2013;148(10):907-914. doi:10.1001/jamasurg.2013.2246.
Text Size: A A A
Published online

Importance  Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators.

Objective  To determine the change in hospital profit due to SSIs.

Design  Retrospective study of data from January 1, 2007, to December 31, 2010.

Setting  The study was performed at 4 of The Johns Hopkins Health System acute care hospitals in Maryland: Johns Hopkins Bayview (560 beds); Howard County General Hospital (238 beds); The Johns Hopkins Hospital (946 beds); and Suburban Hospital (229 beds).

Participants  Eligible patients for the study included those patients admitted to the 4 hospitals between January 1, 2007, and December 31, 2010, with complete data and the correct International Classification of Diseases, Ninth Revision code, as determined by the infection preventionist. Infection preventionists performed complete medical record review using National Healthcare Safety Network definitions to identify SSIs. Patients were stratified using the All Patient Refined Diagnosis Related Groups to estimate the change in hospital profit due to SSIs.

Exposure  Surgical site infections.

Main Outcomes and Measures  The outcomes of the study were the difference in daily total charges, length of stay (LOS), 30-day readmission rate, and profit for patients with an SSI when compared with patients without an SSI. The hypothesis, formulated prior to data collection, that patients with an SSI have higher daily total costs, a longer LOS, and higher 30-day readmission rates than patients without an SSI, was tested using a nonpaired Mann-Whitney U test, an analysis of covariance, and a Pearson χ2 test. Hospital charges were used as a proxy for hospital cost.

Results  The daily total charges, mean LOS, and 30-day readmission rate for patients with an SSI compared with patients without an SSI were $7493 vs $7924 (P = .99); 10.56 days vs 5.64 days (P < .001); and 51.94 vs 8.19 readmissions per 100 procedures (P < .001). The change in profit due SSIs was $2 268 589.

Conclusions and Relevance  The data suggest that hospitals have a financial incentive to reduce SSIs, but hospitals should expect to see an increase in both cost and revenue when SSIs are reduced.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Figure 1.
Mean Daily Total Charges for a Patient vs the Length of Stay for the Patient
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Equation to Determine Change in Profit Due to a Single Surgical Site Infection (SSI)

The equation is used for all i SSIs. The results must be summed for all i SSIs to derive the total change in profit for the health system or hospital due to SSIs. ICU indicates intensive care unit and LOS, length of stay.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Equation to Determine Change in Profit Due to a Single Surgical Site Infection (SSI), Assuming That Payers Will Not Reimburse for Related 30-Day Readmissions

The equation is used for all i SSIs. The results must be summed for all i SSIs to derive the total change in profit for the health system or hospital due to SSIs. ICU indicates intensive care unit and LOS, length of stay.

Graphic Jump Location

Tables

References

Correspondence

CME


You need to register in order to view this quiz.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();