• Giampaolo Greco, Wei Shi, Robert E Michler, David O Meltzer, Gorav Ailawadi, Samuel F Hohmann, Vinod H Thourani, Michael Argenziano, John H Alexander, Kathy Sankovic, Lopa Gupta, Eugene H Blackstone, Michael A Acker, Mark J Russo, Albert Lee, Sandra G Burks, Annetine C Gelijns, Emilia Bagiella, Alan J Moskowitz, and Timothy J Gardner.
• 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.
• J. Am. Coll. Cardiol. 2015 Jan 6;65(1):15-23.

BackgroundHealth 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.ObjectivesThis research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery.MethodsProspectively 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.ResultsAmong 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.ConclusionsHospital 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).Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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