Hospital-Acquired Conditions Increase Costs Among Medicaid Patients Following Surgery

According to a study published online in Gynecologic Oncology, following surgery for patients with gynecologic cancer, hospital-acquired conditions—which were associated with higher hospital charges—were more commonly reported among Medicaid insured patients and older patients.

In order to evaluate hospital-acquired conditions following oophorectomy and/or hysterectomy for gynecologic cancer patients based on clinical outcomes and costs, a research team led by John K. Chan, MD, director of Gynecologic Oncology and specialist in the surgical and medical treatment of ovarian and other complex pelvic cancers at the UCSF Helen Diller Family Comprehensive Cancer Center, and colleagues, examined data from the Nationwide Inpatient Sample from 2005 to 2011. The researchers used Chi-squared and Wilcoxon rank sum two-sample tests and multivariate logistic regression models for statistical analysis.  

For the study, the researchers identified 82,304 women averaging 60 years of age. Of those women, 49,386 (60.0%) had endometrial cancer, 23,510 (28.6%) had ovarian cancer, and 9408 (11.4%) had cervical cancer. The researchers identified 135 hospital-acquired conditions including, catheter-associated urinary tract infections (n = 47), vascular catheter-associated infection (n = 41), foreign object retained after surgery (n = 19), pressure ulcers (n = 16), manifestation of poor glycemic control (n = 10), and air embolism (n = 2).

According to the findings, older patients—greater than 60 years of age—experienced more hospital-acquired conditions compared to younger patients (0.23% vs. 0.09%; OR = 2.13, 95% CI: 1.30–3.50; P = 0.003). Further, patients with Medicaid experienced more hospital-acquired conditions compared to those with private insurance (0.35% vs. 0.10%; OR = 3.09, 95% CI: 1.70–5.62; P < 0.001). Additionally, patients who underwent laparoscopic surgeries experienced less hospital-acquired conditions compared to open surgeries (0.05% vs. 0.19%; OR = 0.41, 95% CI: 0.19–0.90; P = 0.03).

Notably, patients who experienced hospital-acquired conditions had longer hospitalizations as well as increased hospital charges compared to patients without these conditions, (12 days vs. 3 days; p < 0.001; $89,324 vs. $31,107; P < 0.001), respectively.

“The odds of hospital-acquired conditions were higher in older patients, open surgery, Medicaid insured with higher associated hospital charges,” Dr Chan and colleagues concluded.

—Julie Gould

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