title: Costs of postoperative sepsis: the business case for quality improvement to reduce postoperative sepsis in veterans affairs hospitals.
abstract: OBJECTIVE
  To estimate the incremental costs associated with sepsis as a complication of general surgery, controlling for patient risk factors that may affect costs (eg, surgical complexity and comorbidity) and hospital-level variation in costs.
  
  
  METHODS
  Database analysis.
  
  
  METHODS
  One hundred eighteen Veterans Health Affairs hospitals.
  
  
  METHODS
  A total of 13 878 patients undergoing general surgery during fiscal year 2006 (October 1, 2005, through September 30, 2006).
  
  
  METHODS
  Incremental costs associated with sepsis as a complication of general surgery (controlling for patient risk factors and hospital-level variation of costs), as well as the increase in costs associated with complications that co-occur with sepsis. Costs were estimated using the Veterans Health Affairs Decision Support System, and patient risk factors and postoperative complications were identified in the Veterans Affairs Surgical Quality Improvement Program database.
  
  
  RESULTS
  Overall, 564 of 13 878 patients undergoing general surgery developed postoperative sepsis, for a rate of 4.1%. The average unadjusted cost for patients with no sepsis was $24 923, whereas the average cost for patients with sepsis was 3.6 times higher at $88 747. In risk-adjusted analyses, the relative costs were 2.28 times greater for patients with sepsis relative to patients without sepsis (95% confidence interval, 2.19-2.38), with the difference in risk-adjusted costs estimated at $26 972 (ie, $21 045 vs $48 017). Sepsis often co-occurred with other types of complications, most frequently with failure to wean the patient from mechanical ventilation after 48 hours (36%), postoperative pneumonia (31%), and reintubation for respiratory or cardiac failure (29%). Costs were highest when sepsis occurred with pneumonia or failure to wean the patient from mechanical ventilation after 48 hours.
  
  
  CONCLUSIONS
  Given the high cost of treating sepsis, a business case can be made for quality improvement initiatives that reduce the likelihood of postoperative sepsis.
authors.affiliation: Department of Internal Medicine, University of Iowa College of Medicine, and Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA. mary.vaughan@va.gov
authors.forename: Mary S
authors.initials: MS
authors.lastname: Vaughan-Sarrazin
authors.forename: Levent
authors.initials: L
authors.lastname: Bayman
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Cullen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017721:Hospital Costs; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement / Q000191:economics; D012307:Risk Factors; D018805:Sepsis / Q000191:economics* / Q000209:etiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects*