Introduction: Recent controversy has surfaced regarding nonpayment for patients developing a hospital acquired condition (HAC) post-operatively. The three most common HACs are surgical site infection (SSI), deep vein thromboembolism (VTE), and urinary tract infection (UTI) and are associated with inferior patient outcomes. Our objective was to analyze the prevalence and risk factors associated with developing a HAC within 30 days following ADS.
Methods: This was a retrospective analysis of prospectively collected data from the NSQIP database of patients; 18 years old undergoing ADS between 2005 and 2012. Patient baseline factors, perioperative data, preoperative labs, and post-operative course were recorded. Patients with and without HAC were compared using multivariate logistic regression analysis with significance defined as p<0.05. Odds ratio (OR) was calculated with a 95% confidence interval.
Results: 793 patients were identified with 19 deaths (0.4%). 54% of patients were female with the average age, 57.1 years (+/- 13.8) years and 48% underwent posterior fusion. The rate of all HAC's was 4.17% (200/4793). Risk factors for a HAC was age>65 yo (OR 1.7,1.2-2.3,95%CI), female (OR 1.4,1.0-1.9,95%CI), prior dependent functional status (OR 2.13,1.3-3.5,95%CI), bleeding disorder (OR 2.1, 1.0-4.5,95%CI), and osteotomies (OR 1.7,1.0-2.8,95%CI). Developing a HAC was associated with longer LOS, longer operative time, and increased mortality and reoperation rates (all p<0.0001).
Conclusions: Specific comorbidities and patient characteristics were risk factors for developing a HAC following ADS. Obtaining a HAC was associated with longer LOS, reoperation and mortality. Nonpayment for HACs should be carefully considered as these may be associated with pre-operative factors rather than intra- or post-operative variables.
Patient Care: Risk factors for hospital acquired conditions (HACs) are important to identify and understand in order to reduce their occurrence.
Learning Objectives: By the conclusion of this session, participants should be able to understand the prevalence and risk factors associated with developing a HAC within 30 days following ADS.