Postop Sepsis More Than Triples Hospitalization Costs

The average cost to treat a patient with postoperative sepsis is 2.28-3.6 times higher than the cost of treating a patient without sepsis, results from a large database analysis demonstrate.

Postoperative sepsis can lead to complications such as kidney failure or depressed heart rate, and an estimated 30% of patients with severe sepsis die within 1 month. Cost estimates for treating postoperative sepsis have ranged from $10,000 to $40,000 per case (Arch. Surg. 2011;146:944-51).

In this study, Mary S. Vaughan-Sarrazin, Ph.D., of the University of Iowa and her colleagues sought to determine the incremental cost associated with sepsis as a complication of general surgery, drawing on data from 118 acute care Veterans Affairs hospitals and the VA Surgical Quality Improvement Program (VASQIP) to identify patient risk factors and postoperative complications. They looked at results for 16,360 patients who underwent surgery performed by a general surgeon between Oct. 1, 2005, and Sept. 30, 2006, including total costs associated with the index admission and all subsequent readmissions within 30 days after surgery.

Of 13,878 patients included in the final analysis, 564 (4.1%) developed postoperative sepsis. A total of 365 had severe sepsis, and 199 had septic shock. The overall rates of sepsis, however, varied by the following criteria:

• Age. Older patients had a greater likelihood of developing sepsis, which occurred in 2.3% of patients younger than age 55 and in 6.1% of patients aged 85 and older.

• Type of surgery. Sepsis was more likely to occur in patients who had surgery involving the stomach (8.0% of patients), pancreas (13.5%), and rectum (8.6%), as well as total colon removal (8.3%) and other intestinal procedures (10.2%).

• Preexisting conditions. Patients with preexisting conditions before the surgery were more likely to develop postoperative sepsis. The largest occurrence was in 24.6% of patients who were ventilator dependent within 48 hours of surgery. There also were high rates of sepsis in patients with dyspnea (7.2%-13.7% of patients), diabetes mellitus (6.0%), loss of more than 10% of body weight preoperatively (8.8%), bleeding disorders (8.9%), open wound or wound infection (5.6%), blood transfusion (14.6%), pneumonia (10.9%), severe chronic obstructive pulmonary disease (6.6%), and acute renal failure (11.2%).

• Laboratory results. Postoperative sepsis occurred in 3.0% of patients whose serum urea nitrogen (SUN) levels were 15 mg/dL or less, and in 9.4% of those whose SUN levels were greater than 30 mg/dL. Sepsis also occurred in 9.3% of patients whose WBC was 20 mcL or greater, and in 13.8% of patients whose albumen level was less than 2.0 mg/dL or higher.

• Other complications. Sepsis often occurred along with other complications, including failure to wean the patient from a mechanical ventilator after 48 hours (35.8% of patients), postoperative pneumonia (30.9%), reintubation for respiratory or cardiac failure (28.7%), and urinary tract infection (18.8%).

Assuming a 4.1% rate of sepsis, as in this study, an average hospital spends $230,000 annually to treat postoperative sepsis in general surgery patients. The average unadjusted cost per patient went from $24,923 for patients with no sepsis to $88,747 for patients with sepsis, the researchers found. The cost increased further to $92,829 for patients with septic shock. Unadjusted costs when sepsis occurred with other conditions were highest in patients with deep vein thrombosis ($134,162), wound dehiscence ($121,801), and pneumonia ($115,182). Sepsis resulting from failure to wean the patient from mechanical ventilation after 48 hours resulted in an estimated cost of $124,895.

In risk-adjusted analysis, the costs for patients with sepsis were 2.28 times higher than for those without ($48,017 per patient vs. $21,045 per patient, respectively), a difference of $26,972.

The mortality rate, quality of life considerations, and costs make a case for hospitals to adopt initiatives to avoid postoperative sepsis and to identify and treat earlier those cases that do occur. Across the VA hospital system, a 10%-15% drop in sepsis rates after general surgery would save $2.8-$4 million, the researchers said.

"Achieving meaningful reductions in complications of surgery requires sustained institutional commitment to encourage quality improvement efforts that bring together surgeons, anesthesiologists, nurses, and other individuals in the surgical process. This study documents that, although time consuming and often expensive, successful efforts to reduce postoperative sepsis may result in substantial cost savings," they concluded.

Potential limitations of the study include the variance in cost estimates among hospitals and the reliance on observational data, they noted.

This study was supported by Merit Review grant IIR-07-151 from the VA Health Services Research and Development Service. The authors had no financial disclosures.

The average cost to treat a patient with postoperative sepsis is 2.28-3.6 times higher than the cost of treating a patient without sepsis, results from a large database analysis demonstrate.

Postoperative sepsis can lead to complications such as kidney failure or depressed heart rate, and an estimated 30% of patients with severe sepsis die within 1 month. Cost estimates for treating postoperative sepsis have ranged from $10,000 to $40,000 per case (Arch. Surg. 2011;146:944-51).

In this study, Mary S. Vaughan-Sarrazin, Ph.D., of the University of Iowa and her colleagues sought to determine the incremental cost associated with sepsis as a complication of general surgery, drawing on data from 118 acute care Veterans Affairs hospitals and the VA Surgical Quality Improvement Program (VASQIP) to identify patient risk factors and postoperative complications. They looked at results for 16,360 patients who underwent surgery performed by a general surgeon between Oct. 1, 2005, and Sept. 30, 2006, including total costs associated with the index admission and all subsequent readmissions within 30 days after surgery.

Of 13,878 patients included in the final analysis, 564 (4.1%) developed postoperative sepsis. A total of 365 had severe sepsis, and 199 had septic shock. The overall rates of sepsis, however, varied by the following criteria:

• Age. Older patients had a greater likelihood of developing sepsis, which occurred in 2.3% of patients younger than age 55 and in 6.1% of patients aged 85 and older.

• Type of surgery. Sepsis was more likely to occur in patients who had surgery involving the stomach (8.0% of patients), pancreas (13.5%), and rectum (8.6%), as well as total colon removal (8.3%) and other intestinal procedures (10.2%).

• Preexisting conditions. Patients with preexisting conditions before the surgery were more likely to develop postoperative sepsis. The largest occurrence was in 24.6% of patients who were ventilator dependent within 48 hours of surgery. There also were high rates of sepsis in patients with dyspnea (7.2%-13.7% of patients), diabetes mellitus (6.0%), loss of more than 10% of body weight preoperatively (8.8%), bleeding disorders (8.9%), open wound or wound infection (5.6%), blood transfusion (14.6%), pneumonia (10.9%), severe chronic obstructive pulmonary disease (6.6%), and acute renal failure (11.2%).

• Laboratory results. Postoperative sepsis occurred in 3.0% of patients whose serum urea nitrogen (SUN) levels were 15 mg/dL or less, and in 9.4% of those whose SUN levels were greater than 30 mg/dL. Sepsis also occurred in 9.3% of patients whose WBC was 20 mcL or greater, and in 13.8% of patients whose albumen level was less than 2.0 mg/dL or higher.

• Other complications. Sepsis often occurred along with other complications, including failure to wean the patient from a mechanical ventilator after 48 hours (35.8% of patients), postoperative pneumonia (30.9%), reintubation for respiratory or cardiac failure (28.7%), and urinary tract infection (18.8%).

Assuming a 4.1% rate of sepsis, as in this study, an average hospital spends $230,000 annually to treat postoperative sepsis in general surgery patients. The average unadjusted cost per patient went from $24,923 for patients with no sepsis to $88,747 for patients with sepsis, the researchers found. The cost increased further to $92,829 for patients with septic shock. Unadjusted costs when sepsis occurred with other conditions were highest in patients with deep vein thrombosis ($134,162), wound dehiscence ($121,801), and pneumonia ($115,182). Sepsis resulting from failure to wean the patient from mechanical ventilation after 48 hours resulted in an estimated cost of $124,895.

In risk-adjusted analysis, the costs for patients with sepsis were 2.28 times higher than for those without ($48,017 per patient vs. $21,045 per patient, respectively), a difference of $26,972.

The mortality rate, quality of life considerations, and costs make a case for hospitals to adopt initiatives to avoid postoperative sepsis and to identify and treat earlier those cases that do occur. Across the VA hospital system, a 10%-15% drop in sepsis rates after general surgery would save $2.8-$4 million, the researchers said.

"Achieving meaningful reductions in complications of surgery requires sustained institutional commitment to encourage quality improvement efforts that bring together surgeons, anesthesiologists, nurses, and other individuals in the surgical process. This study documents that, although time consuming and often expensive, successful efforts to reduce postoperative sepsis may result in substantial cost savings," they concluded.

Potential limitations of the study include the variance in cost estimates among hospitals and the reliance on observational data, they noted.

This study was supported by Merit Review grant IIR-07-151 from the VA Health Services Research and Development Service. The authors had no financial disclosures.

The average cost to treat a patient with postoperative sepsis is 2.28-3.6 times higher than the cost of treating a patient without sepsis, results from a large database analysis demonstrate.

Postoperative sepsis can lead to complications such as kidney failure or depressed heart rate, and an estimated 30% of patients with severe sepsis die within 1 month. Cost estimates for treating postoperative sepsis have ranged from $10,000 to $40,000 per case (Arch. Surg. 2011;146:944-51).

In this study, Mary S. Vaughan-Sarrazin, Ph.D., of the University of Iowa and her colleagues sought to determine the incremental cost associated with sepsis as a complication of general surgery, drawing on data from 118 acute care Veterans Affairs hospitals and the VA Surgical Quality Improvement Program (VASQIP) to identify patient risk factors and postoperative complications. They looked at results for 16,360 patients who underwent surgery performed by a general surgeon between Oct. 1, 2005, and Sept. 30, 2006, including total costs associated with the index admission and all subsequent readmissions within 30 days after surgery.

Of 13,878 patients included in the final analysis, 564 (4.1%) developed postoperative sepsis. A total of 365 had severe sepsis, and 199 had septic shock. The overall rates of sepsis, however, varied by the following criteria:

• Age. Older patients had a greater likelihood of developing sepsis, which occurred in 2.3% of patients younger than age 55 and in 6.1% of patients aged 85 and older.

• Type of surgery. Sepsis was more likely to occur in patients who had surgery involving the stomach (8.0% of patients), pancreas (13.5%), and rectum (8.6%), as well as total colon removal (8.3%) and other intestinal procedures (10.2%).

• Preexisting conditions. Patients with preexisting conditions before the surgery were more likely to develop postoperative sepsis. The largest occurrence was in 24.6% of patients who were ventilator dependent within 48 hours of surgery. There also were high rates of sepsis in patients with dyspnea (7.2%-13.7% of patients), diabetes mellitus (6.0%), loss of more than 10% of body weight preoperatively (8.8%), bleeding disorders (8.9%), open wound or wound infection (5.6%), blood transfusion (14.6%), pneumonia (10.9%), severe chronic obstructive pulmonary disease (6.6%), and acute renal failure (11.2%).

• Laboratory results. Postoperative sepsis occurred in 3.0% of patients whose serum urea nitrogen (SUN) levels were 15 mg/dL or less, and in 9.4% of those whose SUN levels were greater than 30 mg/dL. Sepsis also occurred in 9.3% of patients whose WBC was 20 mcL or greater, and in 13.8% of patients whose albumen level was less than 2.0 mg/dL or higher.

• Other complications. Sepsis often occurred along with other complications, including failure to wean the patient from a mechanical ventilator after 48 hours (35.8% of patients), postoperative pneumonia (30.9%), reintubation for respiratory or cardiac failure (28.7%), and urinary tract infection (18.8%).

Assuming a 4.1% rate of sepsis, as in this study, an average hospital spends $230,000 annually to treat postoperative sepsis in general surgery patients. The average unadjusted cost per patient went from $24,923 for patients with no sepsis to $88,747 for patients with sepsis, the researchers found. The cost increased further to $92,829 for patients with septic shock. Unadjusted costs when sepsis occurred with other conditions were highest in patients with deep vein thrombosis ($134,162), wound dehiscence ($121,801), and pneumonia ($115,182). Sepsis resulting from failure to wean the patient from mechanical ventilation after 48 hours resulted in an estimated cost of $124,895.

In risk-adjusted analysis, the costs for patients with sepsis were 2.28 times higher than for those without ($48,017 per patient vs. $21,045 per patient, respectively), a difference of $26,972.

The mortality rate, quality of life considerations, and costs make a case for hospitals to adopt initiatives to avoid postoperative sepsis and to identify and treat earlier those cases that do occur. Across the VA hospital system, a 10%-15% drop in sepsis rates after general surgery would save $2.8-$4 million, the researchers said.

"Achieving meaningful reductions in complications of surgery requires sustained institutional commitment to encourage quality improvement efforts that bring together surgeons, anesthesiologists, nurses, and other individuals in the surgical process. This study documents that, although time consuming and often expensive, successful efforts to reduce postoperative sepsis may result in substantial cost savings," they concluded.

Potential limitations of the study include the variance in cost estimates among hospitals and the reliance on observational data, they noted.

This study was supported by Merit Review grant IIR-07-151 from the VA Health Services Research and Development Service. The authors had no financial disclosures.