Abstract
Purpose
Unlike infections related to chemotherapy-induced neutropenia, postoperative infections occurring in patients with solid malignancy remain largely understudied. Our aim is to evaluate the outcomes and the volume–outcomes relationship associated with postoperative infections following resection of common solid tumors.
Methods
We used Texas Discharge Data to study patients undergoing resection of cancer of the lung, esophagus, stomach, pancreas, colon, or rectum from 01/2002 to 11/2006. From their billing records, we identified ICD-9 codes indicating a diagnosis of serious postoperative infection (SPI), i.e., bacteremia/sepsis, pneumonia, and wound infection, occurring during surgical admission or leading to readmission within 30 days of surgery. Using regression-based techniques, we estimated the impact of SPI on mortality, resource utilization, and costs, as well as the relationship between hospital volume and SPI, after adjusting for confounders and data clustering.
Results
SPI occurred following 9.4 % of the 37,582 eligible tumor resections and was independently associated with nearly 12-fold increased odds of in-hospital mortality [95 % confidence interval (95 % CI), 7.2–19.5, P < 0.001]. Patients with SPI required six additional hospital days (95 % CI, 5.9–6.2) at an incremental cost of $16,991 (95 % CI, $16,495–$17,497). Patients who underwent resection at high-volume hospitals had a 16 % decreased odds of developing SPI than those at low-volume hospitals (P = 0.03).
Conclusions
Due to the substantial burden associated with SPI following common solid tumor resections, hospitals must identify more effective prophylactic measures to avert these potentially preventable infections. Additional volume–outcomes research is needed to identify infection prevention processes that can be transferred from high- to lower-volume providers.
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References
Klevens RM, Edwards JR, Richards CL Jr, Horan TC, Gaynes RP et al (2007) Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 122:160–166
American Cancer Society. Infections in individuals with cancer. Available at URL: http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Infections_in_People_with_Cancer.asp [accessed September 13, 2009]
Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database: Incidence—SEER 9 Regs Limited-Use, Nov 2007 Sub (1973–2005) <Katrina/Rita Population Adjustment>—Linked To County Attributes—Total U.S., 1969–2005 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2008, based on the November 2007 submission
Department of Health and Human Services, Centers for Medicare and Medicaid Services (2001) Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2002 rates; final rule. Fed Regist 66:39827–40102
Department of Health and Human Services, Centers for Medicare and Medicaid Services (2003) Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2003 rates; final rule. Fed Regist 67:49982–50289
Department of Health and Human Services, Centers for Medicare and Medicaid Services (2003) Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2004 rates; final rule. Fed Regist 68:45345–45672
Department of Health and Human Services, Centers for Medicare and Medicaid Services (2004) Medicare Program; changes to the hospital inpatient prospective payment systems and fiscal year 2005 rates; final rule. Fed Regist 69:48916–48964
Department of Health and Human Services, Centers for Medicare and Medicaid Services (2005) Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2006 rates; final rule. Fed Regist 70:47278–47707
U.S. Department of Labor. Bureau of Labor Statistics. Consumer Price Indexes. Available at URL: http://data.bls.gov/cgi-bin/surveymost?cu [accessed February 2012]
Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA (2006) Volume and process of care in high-risk cancer surgery. Cancer 106:2476–2481
U.S. Census Bureau–United States Department of Commerce. State Interim Population Projections by Age and Sex. Available at URL:http://www.census.gov/population/www/projections/projectionsagesex.html [accessed October 25, 2007]
Bagger JP, Zindrou D, Taylor KM (2004) Postoperative infection with methicillin-resistant Staphylococcus aureus and socioeconomic background. Lancet 363:706–708
Gornick ME, Eggers PW, Reilly TW, Mentnech RM, Fitterman LK et al (1996) Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med 335:791–799
Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82:703–710
U.S. Census Bureau–United States Department of Commerce (2000) United States Census. Summary File 3. Available at URL:http://www.census.gov/Press-Release/www/2002/sumfile3.html [accessed May 2008]
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383
Iezzoni LI, Foley SM, Heeren T, Daley J, Duncan CC et al (1992) A method for screening the quality of hospital care using administrative data: preliminary validation results. QRB Qual Rev Bull 18:361–371
Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46:1075–1079, discussion 1081–1090
Lawthers AG, McCarthy EP, Davis RB, Peterson LE, Palmer RH et al (2000) Identification of in-hospital complications from claims data. Is it valid? Med Care 38:785–795
McCarthy EP, Iezzoni LI, Davis RB, Palmer RH, Cahalane M et al (2000) Does clinical evidence support ICD-9-CM diagnosis coding of complications? Med Care 38:868–876
Romano PS, Chan BK, Schembri ME, Rainwater JA (2002) Can administrative data be used to compare postoperative complication rates across hospitals? Med Care 40:856–867
Rosen AK, Geraci JM, Ash AS, McNiff KJ, Moskowitz MA (1992) Postoperative adverse events of common surgical procedures in the Medicare population. Med Care 30:753–765
The U.S. Office of Rural Health Policy. List of Rural Counties And Designated Eligible Census Tracts in Metropolitan Counties. Available at URL: ftp://ftp.hrsa.gov/ruralhealth/Eligibility2005.pdf [accessed November 2009]
National Cancer Institute. NCI Designated Cancer Centers. Available at URL: http://cancercenters.cancer.gov/cancer_centers/cancer-centers-list.html [accessed October 25, 2007]
Manning WG, Basu A, Mullahy J (2005) Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ 24:465–488
Roberts RR, Scott RD 2nd, Cordell R, Solomon SL, Steele L et al (2003) The use of economic modeling to determine the hospital costs associated with nosocomial infections. Clin Infect Dis 36:1424–1432
Haley RW, White JW, Culver DH, Hughes JM (1987) The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system. An empirical determination from a nationally representative sample. JAMA 257:1611–1614
Haley RW, Culver DH, White JW, Morgan WM, Emori TG et al (1985) The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 121:182–205
Harbarth S, Sax H, Gastmeier P (2003) The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 54:258–266, quiz 321
Anderson DJ, Hartwig MG, Pappas T, Sexton DJ, Kanafani ZA et al (2008) Surgical volume and the risk of surgical site infection in community hospitals: size matters. Ann Surg 247:343–349
Farber BF, Kaiser DL, Wenzel RP (1981) Relation between surgical volume and incidence of postoperative wound infection. N Engl J Med 305:200–204
Muilwijk J, van den Hof S, Wille JC (2007) Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network. Infect Control Hosp Epidemiol 28:557–563
Wu SC, Chen CC, Ng YY, Chu HF (2006) The relationship between surgical site infection and volume of coronary artery bypass graft surgeries: Taiwan experience. Infect Control Hosp Epidemiol 27:308–311
Thompson DA, Makary MA, Dorman T, Pronovost PJ (2006) Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg 243:547–552
Jarvis WR (1996) Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 17:552–557
Zhan C, Miller MR (2003) Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 290:1868–1874
Digiovine B, Chenoweth C, Watts C, Higgins M (1999) The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 160:976–981
Haley RW, Culver DH, White JW, Morgan WM, Emori TG (1985) The nationwide nosocomial infection rate. A new need for vital statistics. Am J Epidemiol 121:159–167
Leu HS, Kaiser DL, Mori M, Woolson RF, Wenzel RP (1989) Hospital-acquired pneumonia. Attributable mortality and morbidity. Am J Epidemiol 129:1258–1267
Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, Kuroyanagi H, Yamaguchi T (2011) Effect of body mass index on short-term outcomes of patients undergoing laparoscopic resection for colorectal cancer: a single institution experience in Japan. Surg Laparosc Endosc Percutan Tech 21(6):409–414
Vogel TR, Dombrovskiy VY, Lowry SF (2010) In-hospital delay of elective surgery for high volume procedures: the impact on infectious complications. J Am Coll Surg 211(6):784–790
Conflicts of interest and source of funding
Supported, in part, by a grant (#RP101207) from the Cancer Prevention and Research Institute of Texas "CERCIT: Comparative Effectiveness Research on Cancer in Texas." No conflicts of interest were declared.
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Avritscher, E.B.C., Cooksley, C.D., Rolston, K.V. et al. Serious postoperative infections following resection of common solid tumors: outcomes, costs, and impact of hospital surgical volume. Support Care Cancer 22, 527–535 (2014). https://doi.org/10.1007/s00520-013-2006-1
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DOI: https://doi.org/10.1007/s00520-013-2006-1