title: The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer.
abstract: OBJECTIVE
  The incidence of hospital acquired adverse events in radical cystectomy and their implications for hospital outcomes and costs remain poorly described. We describe the incidence of hospital acquired adverse events in radical cystectomy, and characterize its relationship with in-hospital mortality, length of stay and hospitalization costs.
  
  
  METHODS
  We identified 10,856 patients who underwent radical cystectomy for bladder cancer at 1,175 hospitals in the Nationwide Inpatient Sample from 2001 to 2008. We used hospital claims to identify adverse events for accidental puncture, decubitus ulcer, deep vein thrombosis/pulmonary embolus, methicillin-resistant Staphylococcus aureus, Clostridium difficile, surgical site infection and sepsis. Logistic regression and generalized estimating equation models were used to test the associations of hospital acquired adverse events with mortality, predicted prolonged length of stay and total hospitalization costs.
  
  
  RESULTS
  Hospital acquired adverse events occurred in 11.3% of all patients undergoing radical cystectomy (1,228). Adverse events were associated with a higher odds of in-hospital death (OR 8.07, p<0.001), adjusted prolonged length of stay (41.3%) and total costs ($54,242 vs $26,306; p<0.001) compared to no adverse events on multivariate analysis. The incremental total costs attributable to hospital acquired adverse events were $43.8 million. Postoperative sepsis was associated with the highest risk of mortality (OR 17.56, p<0.001), predicted prolonged length of stay (62.22%) and adjusted total cost ($79,613).
  
  
  CONCLUSIONS
  With hospital acquired adverse events occurring in approximately 11% of radical cystectomy cases, they pose a significant risk of in-hospital mortality and higher hospitalization costs. Therefore, increased attention is needed to reduce adverse events by improving patient safety, while understanding the economic implications for tertiary referral centers with possible policy changes such as denial of payment for hospital acquired adverse events.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA. simkim@me.com
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
authors.forename: Igor
authors.initials: I
authors.lastname: Frank
authors.forename: James P
authors.initials: JP
authors.lastname: Moriarty
authors.forename: Leona C
authors.initials: LC
authors.lastname: Han
authors.forename: Bijan
authors.initials: B
authors.lastname: Borah
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tollefson
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality*; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D001749:Urinary Bladder Neoplasms / Q000191:economics / Q000601:surgery*