Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich.
J Thorac Cardiovasc Surg. 2022 Nov;164(5):1561-1568. doi: 10.1016/j.jtcvs.2021.04.074. Epub 2021 May 4.
The objective of this study was to investigate variations across hospitals in infection rates and associated costs, the latter reflected in 90-day Medicare payments. Despite high rates and expenditures of health care--associated infections associated with durable ventricular assist device implantation, few studies have examined interhospital variation and associated costs.
Clinical data on 8688 patients who received primary durable ventricular assist devices from July 2008 to July 2017 from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) were merged with postimplantation 90-day Medicare claims. Terciles of hospital-specific, risk-adjusted infection rates per 100 patient-months were estimated using Intermacs and associated with Medicare payments (among 5440 Medicare beneficiaries). Primary outcomes included infections within 90 days of implantation and Medicare payments.
There were 3982 infections identified among 27.8% (2417/8688) of patients developing an infection. The median (25th, 75th percentile) adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 (9.3, 19.5) and varied according to hospital (range, 0.0-35.6). Total Medicare payments from implantation to 90 days were 9.0% (absolute difference: $13,652) greater in high versus low infection tercile hospitals (P < .0001). The period between implantation to discharge accounted for 73.1% of the difference in payments during the implantation to 90-day period across terciles.
Health care--associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures. Interventions targeting preventing infections could improve the value of durable ventricular assist device support from the societal and hospital perspectives.
本研究旨在调查医院间感染率及相关费用的差异，后者反映在 90 天的医疗保险支付中。尽管与永久性心室辅助装置植入相关的医疗保健相关感染率和支出率很高，但很少有研究检查过医院间的差异和相关成本。
将 2008 年 7 月至 2017 年 7 月期间来自胸外科医师学会机械循环支持机构间注册中心（Intermacs）医院的 8688 名接受初次永久性心室辅助装置的患者的临床数据（n=120）与植入后 90 天的医疗保险索赔进行合并。使用 Intermacs 估计每 100 个患者月特定医院风险调整后感染率的三分位数，并与 5440 名医疗保险受益人的医疗保险支付情况相关（n=5440）。主要结局包括植入后 90 天内的感染和医疗保险支付。
在发生感染的 27.8%（2417/8688）患者中，共发现 3982 例感染。医院间调整后的感染发生率（每 100 个患者月）中位数（25 分位，75 分位）为 14.3（9.3，19.5），且因医院而异（范围：0.0-35.6）。高感染率三分位组与低感染率三分位组相比，从植入到 90 天的医疗保险总支付额高出 9.0%（绝对差值：13652 美元）（P<.0001）。在三个三分位组中，植入到出院期间的支付差异占植入到 90 天期间支付差异的 73.1%。
永久性心室辅助装置植入后，医疗保健相关感染率因医院而异，并与 90 天医疗保险支出增加相关。针对预防感染的干预措施可能会从社会和医院的角度提高永久性心室辅助装置支持的价值。
