Evidence map›Paper›PMID 37880706›Full record

ArticleBMC health services research2023

Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study.

Y Raja Rampersaud, Kala Sundararajan, Shgufta Docter, Anthony V Perruccio, Rajiv Gandhi, Diana Adams, Natasha Briggs, J Rod Davey, Michael Fehlings, Stephen J Lewis and 6 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 3 institutions in 1 country.

Y Raja Rampersaud *Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada. Raja.Rampersaud@uhn.ca.
Kala Sundararajan *Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Shgufta DocterDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Anthony V PerruccioDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Rajiv GandhiDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Diana AdamsDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Natasha BriggsDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
J Rod DaveyDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Michael FehlingsKrembil Research Institute, University Health Network, Toronto, ON, Canada.
Stephen J LewisDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Rosalie MagtotoDivision of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
Eric MassicotteKrembil Research Institute, University Health Network, Toronto, ON, Canada.
Angela SarroDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Khalid SyedDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Nizar N MahomedDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
Christian VeilletteDivision of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
University Health Network · CAKrembil Research InstituteUniversity of Toronto · CA

Funding

Arthritis Society STAR-20-0000000012
6 · The paper itself

Abstract

backgroundThe incremental hospital cost and length of stay (LOS) associated with adverse events (AEs) has not been well characterized for planned and unplanned inpatient spine, hip, and knee surgeries.

methodsRetrospective cohort study of hip, knee, and spine surgeries at an academic hospital in 2011-2012. Adverse events were prospectively collected for 3,063 inpatient cases using the Orthopaedic Surgical AdVerse Event Severity (OrthoSAVES) reporting tool. Case costs were retrospectively obtained and inflated to equivalent 2021 CAD values. Propensity score methodology was used to assess the cost and LOS attributable to AEs, controlling for a variety of patient and procedure factors.

resultsThe sample was 55% female and average age was 64; 79% of admissions were planned. 30% of cases had one or more AEs (82% had low-severity AEs at worst). The incremental cost and LOS attributable to AEs were $8,500 (95% confidence interval [CI]: 5100-11,800) and 4.7 days (95% CI: 3.4-5.9) per admission. This corresponded to a cumulative $7.8 M (14% of total cohort cost) and 4,290 bed-days (19% of cohort bed-days) attributable to AEs. Incremental estimates varied substantially by (1) admission type (planned: $4,700/2.4 days; unplanned: $20,700/11.5 days), (2) AE severity (low: $4,000/3.1 days; high: $29,500/11.9 days), and (3) anatomical region (spine: $19,800/9 days; hip: $4,900/3.8 days; knee: $1,900/1.5 days). Despite only 21% of admissions being unplanned, adverse events in these admissions cumulatively accounted for 59% of costs and 62% of bed-days attributable to AEs.

conclusionsThis study comprehensively demonstrates the considerable cost and LOS attributable to AEs in orthopaedic and spine admissions. In particular, the incremental cost and LOS attributable to AEs per admission were almost five times as high among unplanned admissions compared to planned admissions. Mitigation strategies focused on unplanned surgeries may result in significant quality improvement and cost savings in the healthcare system.

Indexed as

InpatientsSpineFemaleHospitalsHumansLength of StayMaleMiddle AgedRetrospective StudiesAdverse eventsComplicationsEconomic evaluationHealth care costsInpatient admissionLength of stayNeurosurgeryOrthopaedic joint surgerySpine surgery

Identifiers

PMID37880706
PMCPMC10598977
OpenAlexW4387939936

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.