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Incidence, Cost, and Mortality Associated With Hospital-Acquired Conditions After Resection of Cranial Neoplasms

Zacharia, Brad E. MD, MS*; Deibert, Christopher MD, MPH; Gupta, Gaurav MD*; Hershman, Dawn MD, MS§,¶; Neugut, Alfred I. MD, PhD§,¶; Bruce, Jeffrey N. MD*; Spencer, Benjamin A. MD, MPH‡,§

doi: 10.1227/NEU.0000000000000342
Research-Human-Clinical Studies

BACKGROUND: In 2007, the Centers for Medicare and Medicaid Services stopped reimbursing for treatment of specified hospital-acquired conditions (HACs), also known as “never events.”

OBJECTIVE: To establish benchmarks for HACs after common neurosurgical oncologic procedures.

METHODS: We identified adults in the Nationwide Inpatient Sample between 2002 and 2009 who underwent resection of a benign or malignant brain tumor. Baseline demographics, medical comorbidities, and hospital-level variables were assessed. A generalized estimating equation, multivariable-logistic model was used to identify predictors of HACs, mortality, prolonged hospital length of stay, and increased hospital charges.

RESULTS: We identified 310,133 patients undergoing surgical treatment of a cranial neoplasm; 5.4% experienced an HAC. More medical comorbidities and the presence of an immediate postoperative neurosurgical complication increased one's risk of having an HAC (odds ratios: 1.56 and 2.48, respectively; both P < .01). Patients who experienced an HAC faced increased in-hospital mortality (6.47% vs 1.53%; P < .01) and increased total hospital costs ($52,882.61 vs $25,569.45; P < .01). Patients at urban teaching hospitals and those with a high surgical volume were more likely to experience an HAC compared with those treated at rural nonteaching hospitals and those with a low surgical volume (odds ratios: 1.33 and 1.16, respectively; P < .01).

CONCLUSION: We found a 5.4% incidence of HACs after neurosurgical oncologic procedures, which varied based on several patient and hospital-level factors. A thorough analysis of the relationship between patient, procedure, and HAC incidence will be important to developing fair compensation practices for physicians as well as payers. Additionally, further investigation may identify opportunities for future quality improvement initiatives.

ABBREVIATIONS: CI, confidence interval

CMS, Centers for Medicare and Medicaid Services

DVT, deep venous thrombosis

HAC, hospital-acquired condition

NIS, Nationwide Inpatient Sample

PE, pulmonary embolism

Departments of *Neurosurgery,


§Medicine, College of Physicians and Surgeons, Columbia University, New York, New York;

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

Correspondence: Brad E. Zacharia, MD, MS Columbia University, College of Physicians and Surgeons, Department of Neurological Surgery, Neurological Institute, 710 W. 168th Street, 4th Floor, New York, NY 10032. E-mail:

Received October 07, 2013

Accepted February 02, 2014

Copyright © by the Congress of Neurological Surgeons