title: Prevalence, impact, and risk factors for hospital-acquired conditions after major surgical resection for cancer: a NSQIP analysis.
abstract: BACKGROUND
  The effectiveness of the CMS nonpayment policy for certain hospital-acquired conditions (HAC) is debated, since their preventability is questionable in several groups of patients. This study aimed to determine the rate of the three most common HAC in major surgical resections for cancer: surgical site infection (SSI), urinary tract infection (UTI), and venous thromboembolism (VTE). Additionally, the association of HAC with patients' characteristics and their effect on post-operative outcomes were investigated.
  
  
  METHODS
  Patients who underwent surgical resection for esophageal, gastric, hepato-biliary, pancreatic, colorectal, and lung cancer were identified using the ACS-NSQIP database (2005-2012). Early surgical outcomes were compared between HAC and non-HAC patients. Modified Poisson regression was used to identify risk factors for developing HAC.
  
  
  RESULTS
  Seventy-four thousand three hundred eighty-one patients were identified, of whom 9,479 (12.74%) developed one or more HAC. HAC patients had significantly higher rates of 30-day mortality, return to operating room, 30-day readmission, had longer LOS, and were less likely to be discharged home. Several peri-operative patients' factors were significantly associated with HAC.
  
  
  CONCLUSIONS
  Our data show that the development of HAC is strongly associated to pre-operative patients' characteristics and not only to sub-optimal peri-operative care, therefore suggesting that the nonpayment policy might be excessively penalizing.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Blalock 240, Baltimore, MD, 21287, USA, dmolena2@jhmi.edu.
authors.forename: Daniela
authors.initials: D
authors.lastname: Molena
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mungo
authors.forename: Miloslawa
authors.initials: M
authors.lastname: Stem
authors.forename: Richard L
authors.initials: RL
authors.lastname: Feinberg
authors.forename: Anne O
authors.initials: AO
authors.lastname: Lidor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D015995:Prevalence; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology