TY - JOUR
T1 - The Influence of Infectious Complications in Gastroschisis on Costs and Length of Stay
AU - Uribe-Leitz, Monika
AU - McCracken, Courtney E.
AU - Heiss, Kurt F.
AU - Wulkan, Mark L.
AU - Raval, Mehul V.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Objective Outcomes for gastroschisis (GS) remain highly variable and avoiding infectious complications (ICs) may represent a significant improvement opportunity. Our objective was to provide estimates of the impact of IC on length of stay (LOS) and costs. Study Design Using a national database, 1,378 patients with GS were identified. Patient and hospital characteristics were compared and LOS and costs evaluated for patients with and without IC. Results Two-thirds of all GS patients had IC, and IC were common for simple and complex GS (65, 73%, respectively). After controlling for patient and hospital factors, LOS in patients with IC was significantly longer than in patients without IC (4.5-day increase, p = 0.001). Specifically, sepsis was associated with increasing median LOS by 11 days (p ≤ 0.001), candida infection by 14 days (p < 0.001), and wound infection by 7 days (p = 0.007). Although overall costs did not differ between patients with and without IC, costs were elevated based on specific IC. Sepsis increased median costs by $22,380 (95% confidence interval [CI]: $14,372-30,388; p ≤ 0.001), wound infection by $32,351 (95% CI: $17,221-47,481; p ≤ 0.001), catheter-related infection by $57,180 (95% CI: $12,834-101,527; p = 0.011), and candida infections by $24,500 (95% CI: $8,832-40,167; p = 0.002). Conclusion IC among GS patients are common and contribute to increased LOS and costs. Quantifying clinical and financial ramifications of IC may help direct future quality improvement efforts.
AB - Objective Outcomes for gastroschisis (GS) remain highly variable and avoiding infectious complications (ICs) may represent a significant improvement opportunity. Our objective was to provide estimates of the impact of IC on length of stay (LOS) and costs. Study Design Using a national database, 1,378 patients with GS were identified. Patient and hospital characteristics were compared and LOS and costs evaluated for patients with and without IC. Results Two-thirds of all GS patients had IC, and IC were common for simple and complex GS (65, 73%, respectively). After controlling for patient and hospital factors, LOS in patients with IC was significantly longer than in patients without IC (4.5-day increase, p = 0.001). Specifically, sepsis was associated with increasing median LOS by 11 days (p ≤ 0.001), candida infection by 14 days (p < 0.001), and wound infection by 7 days (p = 0.007). Although overall costs did not differ between patients with and without IC, costs were elevated based on specific IC. Sepsis increased median costs by $22,380 (95% confidence interval [CI]: $14,372-30,388; p ≤ 0.001), wound infection by $32,351 (95% CI: $17,221-47,481; p ≤ 0.001), catheter-related infection by $57,180 (95% CI: $12,834-101,527; p = 0.011), and candida infections by $24,500 (95% CI: $8,832-40,167; p = 0.002). Conclusion IC among GS patients are common and contribute to increased LOS and costs. Quantifying clinical and financial ramifications of IC may help direct future quality improvement efforts.
KW - costs
KW - gastroschisis
KW - infections
KW - length of stay
KW - quality improvement
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U2 - 10.1055/s-0036-1584299
DO - 10.1055/s-0036-1584299
M3 - Article
C2 - 27240097
AN - SCOPUS:84973163543
SN - 0735-1631
VL - 34
SP - 62
EP - 69
JO - American Journal of Perinatology
JF - American Journal of Perinatology
IS - 1
ER -