title: Risk-adjusted increases in medical resource utilization associated with health care-associated infections in gastrectomy patients.
abstract: OBJECTIVE
  Quantifying the impact of health care-associated infections (HAIs) on medical resource utilization is necessary for payers and providers to appropriately allocate limited resources for interventions. However, previous studies tend to involve single institutions and do not take into account patient and practice variations between several hospitals. The objective of this study was to conduct a multi-institutional risk-adjusted comparison of HAI-associated impact on medical resources in gastrectomy patients in Japan.
  
  
  METHODS
  Health care-associated infections were identified using a combination of International Classification of Diseases-10 codes and antibiotic utilization patterns in 1058 gastrectomy patients from 10 Japanese hospitals. Multiple linear regression models and risk adjustment were used to analyse the impact of HAIs on: (1) total hospital costs; (2) antibiotic costs; and (3) post-surgical length of stay (LOS).
  
  
  RESULTS
  Overall HAI incidence for the database was 20.3%, with a range of 8.8-29.6% among the 10 hospitals. Regression models showed that HAIs were significantly associated with increases in all three indicators. Risk-adjusted comparisons revealed that HAIs were associated with an increase of US$2767 (range: US$1035-6513) in overall hospital cost, US$202 (US$98.8-764.6) antibiotic costs and 10.6 (4.7-24 days) post-surgical LOS days.
  
  
  CONCLUSIONS
  Even after adjusting for patient characteristics and other variables, there was still a high degree of variation observed in the impact of HAIs on total hospital costs and antibiotic costs from a third-party payer's perspective and post-surgical LOS among the 10 hospitals. This information can increase the efficiency of allocation of resources for interventions to reduce HAIs.
authors.affiliation: Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Jason
authors.initials: J
authors.lastname: Lee
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
authors.forename: Miho
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Ishizaki
authors.forename: Kenshi
authors.initials: K
authors.lastname: Hayashida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikai
authors.forename: Otsubo
authors.initials: O
authors.lastname: Tetsuya
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis / Q000191:economics; D003428:Cross Infection / Q000191:economics* / Q000517:prevention & control; D005260:Female; D005743:Gastrectomy / Q000191:economics*; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006801:Humans; D007564:Japan; D007902:Length of Stay / Q000191:economics; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D020379:Risk Adjustment