Subjects: Quality and safety
Patient risk factors like advanced age increase the likelihood of some so-called “never events” in hospitals, according to a report in last month’s Archives of Surgery. The findings do not support Medicare’s current policy of denying payments associated with treatments for such events.
To reach this conclusion, Donald Fry and colleagues analyzed 890,000 surgeries in 1,368 hospitals using the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample. They studied abdominal hysterectomy, aorto-femoral bypass, colon resection, coronary artery bypass grafting and total hip replacement.
The researchers looked for associations between patient factors like comorbidities, age and gender and 8 “never event” complications, including C. difficile, MRSA, and surgical site infections, catheter-associated vascular and urinary tract infections, mediastinitis after CABG, decubitus ulcers and post-operative pneumonia.
They found that patient age and comorbid conditions like renal failure and weight loss were associated with a much higher risk of many of these “never event” complications.
The odds ratios ranged from 1.8 for unscheduled admission as a predictor for C. difficile enterocolitis to 16.4 for malnutrition and weight loss as a risk factor for intravascular device infection.
“Calling these complications never events and refusing to pay for their treatment may advantage high-quality caregivers, but it also will penalize providers that care for the most vulnerable patients or that perform procedures with higher-than-average risk,” Fry’s group wrote.
Medicare’s “never events” list was implemented 2 years ago. It includes obvious mistakes like transfusing the wrong blood type and wrong-site surgeries.
But the list also features complications that may not be preventable. In addition to those mentioned above, the list includes falls in the hospital, inadequate blood glucose control, pulmonary embolism and drug-induced delerium.