Hospital-acquired conditions (HACs) are used to define hospital performance measures. Patient comorbidity may influence HAC development. The National Inpatient Sample database was used to investigate HACs for the patients who underwent liver transplantation. Multivariate analysis was used to identify HAC risk factors. We found a total of 13,816 patients who underwent liver transplantation during 2002–2014. Of these, 330 (2.4%) had a report of HACs. Most frequent HACs were vascular catheter–associated infection [220 (1.6%)], falls and trauma [66 (0.5%), catheter-associated UTI [24 (0.2%)], and pressure ulcer stage III/IV [22 (0.2%)]. Factors correlating with HACs included extreme loss function (AOR: 52.13, P < 0.01) and major loss function (AOR: 8.11, P = 0.04), hepatopulmonary syndrome (AOR: 3.39, P = 0.02), portal hypertension (AOR: 1.49, P = 0.02), and hospitalization length of stay before transplant (AOR: 1.01, P < 0.01). The rate of HACs for liver transplantation is three times higher than the reported overall rate of HACs for GI procedures. Multiple patient factors are associated with HACs, and HACs may not be a reliable measure to evaluate hospital performance. Vascular catheter–associated infection is the most common HAC after liver transplantation.
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References
1.
TeufackS.G., CampbellP., JabbourP.Potential financial impact of restriction in “never event” and periprocedural hospital-acquired condition reimbursement at a tertiary neurosurgical center: a single-institution prospective study.J Neurosurg2010; 112: 249–56.
2.
LembitzA., ClarkeT.J.Clarifying “never events and introducing” always events”.Patient Saf Surg2009; 3: 26.
3.
MehtsunW.T., IbrahimA.M., Diener-WestM.Surgical never events in the United States.Surgery2013; 153: 465–72.
4.
NeroD.C., LippM.J., CallahanM.A.The financial impact of hospital-acquired conditions.J Health Care Finance2012; 38: 40–9.
5.
ChurchS., RobinsonT.N., AnglesE.M.Postoperative falls in the acute hospital setting: characteristics, risk factors, and outcomes in males.Am J Surg2011; 201: 197–202.
KwonS., ThompsonR., DellingerP.Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program.Ann Surg2013; 257: 8–14.
8.
PessauxP., MsikaS., AtallaD.Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients.Arch Surg2003; 138: 314–24.
9.
van HoekB., de RooijB.J., VerspagetH.W.Risk factors for infection after liver transplantation.Best Pract Res Clin Gastroenterol2012; 26: 61–72.
10.
HCUP Nationwide Inpatient Sample (NIS).Healthcare Cost and Utilization Project (HCUP). 2002–2014.Agency for Healthcare Research and QualityRockville, MD.www.hcup-us.ahrq.gov/nisoverview.jsp.
11.
ShahN.K., FarberA., KalishJ.A.Occurrence of “never events” after major open vascular surgery procedures.J Vasc Surg2016; 63: 738–45. e728.
12.
WenT., HeS., AttenelloF.The impact of patient age and comorbidities on the occurrence of “never events” in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample.J Neurosurg2014; 121: 580–6.
13.
LidorA.O., Moran-AtkinE., StemM.Hospital-acquired conditions after bariatric surgery: we can predict, but can we prevent?Surg Endosc2014; 28: 3285–92.
14.
MoghadamyeghanehZ., ChenL.J., AlameddineM.Never events and hospital-acquired conditions after kidney transplant.Can Urol Assoc J2017; 11: E431–6.
15.
ShahN.K., FarberA., KalishJ.A.Occurrence of “never events” after major open vascular surgery procedures.J Vasc Surg2016; 63: 738–45. e728.
16.
LawsonE.H., ZingmondD.S., HallB.L.Comparison between clinical registry and medicare claims data on the classification of hospital quality of surgical care.Ann Surg2015; 261: 290–6.
17.
LawsonE.H., LouieR., ZingmondD.S.A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications.Ann Surg2012; 256: 973–81.
18.
LiuJ.B., BerianJ.R., ChenS.Postoperative complications and hospital payment: implications for achieving value.J Am Coll Surg2017; 224: 779–86. e772.
19.
WintersB.D., BharmalA., WilsonR.F.Validity of the agency for health care research and quality patient safety indicators and the centers for medicare and medicaid hospital-acquired conditions: a systematic review and meta-analysis.Med Care2016; 54: 1105–11.
20.
RajaramR., ChungJ.W., KinnierC.V.Hospital characteristics associated with penalties in the centers for medicare & medicaid services hospital-acquired condition reduction program.J Am Med Assoc2015; 314: 375–83.
21.
ItaniK.M.Fifteen years of the national surgical quality improvement program in review.Am J Surg2009; 198: S9–18.
22.
MermelL.A.Prevention of intravascular catheter-related infections.Ann Intern Med2000; 132: 391–402.
23.
RichetH., HubertB., NitembergG.Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients.J Clin Microbiol1990; 28: 2520–5.
24.
O'GradyN.P., AlexanderM., BurnsL.A.Guidelines for the prevention of intravascular catheter-related infections.Clin Infect Dis2011; 52: e162–93.
25.
LorenceD.P., IbrahimI.A.Benchmarking variation in coding accuracy across the United States.J Health Care Finance2003; 29: 29–42.
26.
DasguptaM., DumbrellA.C.Preoperative risk assessment for delirium after noncardiac surgery: a systematic review.J Am Geriatr Soc2006; 54: 1578–89.
27.
RobinsonT.N., RaeburnC.D., TranZ.V.Postoperative delirium in the elderly: risk factors and outcomes.Ann Surg2009; 249: 173–8.
28.
BerthelsenC.L.Evaluation of coding data quality of the HCUP national inpatient sample.Top Health Inf Manage2000; 21: 10–23.
