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Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers

Spector, William D., PhD; Limcangco, Rhona, PhD; Owens, Pamela L., PhD; Steiner, Claudia A., MD, MPH

doi: 10.1097/MLR.0000000000000558
Original Articles

Background: Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs).

Objective: To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics.

Research Design and Subjects: Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression.

Results: We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900.

Conclusions: This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

*Agency for Healthcare Research & Quality, US Department of Health & Human Services, Rockville

Social & Scientific Systems Inc., Silver Spring, MD

The authors declare no conflict of interest.

Reprints: William D. Spector, PhD, Agency for Healthcare Research & Quality, US Department of Health & Human Services, 5600 Fishers Lane, Mailstop #7W25B, Rockville, MD, 20857. E-mail:

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