title: Costs associated with health care-associated infections in cardiac surgery.
abstract: BACKGROUND
  Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited.
  
  
  OBJECTIVE
  This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery.
  
  
  METHODS
  Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type.
  
  
  RESULTS
  Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs.
  
  
  CONCLUSIONS
  Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York. Electronic address: giampaolo.greco@mountsinai.org.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Greco
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
authors.forename: Wei
authors.initials: W
authors.lastname: Shi
authors.affiliation: Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Michler
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.affiliation: University HealthSystem Consortium, Chicago, Illinois.
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Hohmann
authors.affiliation: Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: John H
authors.initials: JH
authors.lastname: Alexander
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Kathy
authors.initials: K
authors.lastname: Sankovic
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
authors.forename: Lopa
authors.initials: L
authors.lastname: Gupta
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.affiliation: Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.affiliation: Barnabas Heart Hospital, Newark, New Jersey.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.affiliation: Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, Bethesda, Maryland.
authors.forename: Albert
authors.initials: A
authors.lastname: Lee
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Burks
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
authors.forename: Annetine C
authors.initials: AC
authors.lastname: Gelijns
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
authors.forename: Emilia
authors.initials: E
authors.lastname: Bagiella
authors.affiliation: International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai Medical Center, New York, New York.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Moskowitz
authors.affiliation: Center for Heart and Vascular Health, Christiana Care Health System, Newark, Delaware.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Gardner
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000191:economics*; D017281:Cost of Illness; D003428:Cross Infection / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged
keywords: health care–associated infection; hospital costs; length of stay