title: The impact of patient age and comorbidities on the occurrence of "never events" in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample.
abstract: OBJECTIVE
  As health care administrators focus on patient safety and cost-effectiveness, methodical assessment of quality outcome measures is critical. In 2008 the Centers for Medicare and Medicaid Services (CMS) published a series of "never events" that included 11 hospital-acquired conditions (HACs) for which related costs of treatment are not reimbursed. Cerebrovascular procedures (CVPs) are complex and are often performed in patients with significant medical comorbidities.
  
  
  METHODS
  This study examines the impact of patient age and medical comorbidities on the occurrence of CMS-defined HACs, as well as the effect of these factors on the length of stay (LOS) and hospitalization charges in patients undergoing common CVPs.
  
  
  RESULTS
  The HACs occurred at a frequency of 0.49% (1.33% in the intracranial procedures and 0.33% in the carotid procedures). Falls/trauma (n = 4610, 72.3% HACs, 357 HACs per 100,000 CVPs) and catheter-associated urinary tract infections (n = 714, 11.2% HACs, 55 HACs per 100,000 CVPs) were the most common events. Age and the presence of ≥ 2 comorbidities were strong independent predictors of HACs (p < 0.0001). The occurrence of HACs negatively impacts both LOS and hospital costs. Patients with at least 1 HAC were 10 times more likely to have prolonged LOS (≥ 90th percentile) (p < 0.0001), and 8 times more likely to have high inpatient costs (≥ 90th percentile) (p < 0.0001) when adjusting for patient and hospital factors.
  
  
  CONCLUSIONS
  Improved quality protocols focused on individual patient characteristics might help to decrease the frequency of HACs in this high-risk population. These data suggest that risk adjustment according to underlying patient factors may be warranted when considering reimbursement for costs related to HACs in the setting of CVPs.
authors: Zilkha Neurogenetic Institute.
authors: Timothy
authors: T
authors: Wen
authors: Shuhan
authors: S
authors: He
authors: Frank
authors: F
authors: Attenello
authors: Steven Y
authors: SY
authors: Cen
authors: May
authors: M
authors: Kim-Tenser
authors: Peter
authors: P
authors: Adamczyk
authors: Arun P
authors: AP
authors: Amar
authors: Nerses
authors: N
authors: Sanossian
authors: William J
authors: WJ
authors: Mack
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S.; D015897:Comorbidity; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D012308:Risk Management; D014481:United States; D014552:Urinary Tract Infections / Q000191:economics / Q000453:epidemiology*
keywords: AHRQ = Agency for Healthcare Research and Quality; AVM = arteriovenous malformation; CAS = carotid artery stenting; CEA = carotid endarterectomy; CMS = Centers for Medicaid and Medicare Services; CVP = cerebrovascular procedure; EC-IC = extracranial-intracranial; HAC = hospital-acquired condition; HCUP = Healthcare Cost and Utilization Project; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; LOS = length of stay; NIS = Nationwide Inpatient Sample; UTI = urinary tract infection; cerebrovascular disease; hospital performance; stroke; surgery; vascular disorders