Preventable Surgical Errors Cost $1.5 Billion

Preventable surgical errors are likely costing insurers more than $1 billion a year, according to a new study by the Agency for Healthcare Research and Quality.

The report provides a fuller accounting of the true cost of potentially preventable errors than had been previously published, according to the authors, William E. Encinosa, Ph.D., and Fred J. Hellinger, Ph.D., both with AHRQ's Center for Delivery, Organization, and Markets.

They looked at the comprehensive, per-episode cost of medical errors, including payments to hospitals for the initial admission and readmission, as well as payments for physicians, for outpatient services, and for prescription drugs. All cost data were included for 90 days after surgical admission.

The authors drew their analysis from the 2001-2002 MarketScan Commercial Claims and Encounter Database, which covers 5.6 million enrollees in private, employer-sponsored plans (Health Serv. Res. 2008 July 25 [doi: 10.1111/j.1475-6773.2008.00882.x

“Most papers that estimate the cost of medical errors only examine the initial hospitalization in which the medical error occurred,” they wrote. But, they added, “we find that the death rate increases by 50% over 90 days once the patient leaves the hospital.”

Postdischarge costs also are often higher than those for the initial admission, they noted. For infections, the excess payments during a 90-day episode were 28% higher.

By looking at an entire episode of care over 90 days, the researchers make a strong argument in favor of spending money on quality, Dr. Darrell A. Campbell, professor of surgery at the University of Michigan, Ann Arbor, said in an interview. “Complications and adverse events are expensive, and if you can avoid them, not only does quality go up, but costs go down.”

The case-control study examined 14 potentially preventable adverse medical events, defined by AHRQ as patient safety indicators. In all 161,004 adult, nonelderly, major surgeries were analyzed; 2.6% (4,140) of cases had at least one of the 14 preventable events, and 5.6% of those cases had additional errors.

Acute respiratory failure was the most common preventable event, which occurred in 0.9% (1,392) of all surgeries. That also was the most expensive event, at $106,000 per instance, and patients who had respiratory failure also had the highest death rate, at about 12% over the 90-day period tracked.

For all patients who had at least one preventable event, the 90-day death rate was higher at 6%, compared with 0.6% for patients who did not have a preventable event. The 90-day readmission rate was 15% for patients with a preventable event, compared with 5.5% for those without.

Overall 23% of patients who experienced potentially preventable events were readmitted, compared with 10% of those without an event. Not surprisingly, overall costs were higher for those patients with events. The 90-day cost for a surgery that included a potentially preventable event was $66,800, compared with $18,200 for a procedure that did not involve such an event.

Lengths of stay were longer, as well, at 22 days for patients with events, compared with 5 days for those without.

By extrapolating the results to the entire population of insured nonelderly adults in the United States, the authors report that 11% of 90-day postdischarge deaths and 2% of 90-day readmissions are due to the 14 potentially preventable adverse events, as are 2% ($1.5 billion) of all 90-day expenses after surgery.

This estimate might be conservative, because there are many costs that could be incurred outside of the 14 preventable errors that were assessed in the report, Dr. Campbell noted.

Going forward, it will be possible to collect stronger data on errors because hospitals are now recording whether certain preventable conditions are present on admission, he said.

ELSEVIER GLOBAL MEDICAL NEWS

Preventable surgical errors are likely costing insurers more than $1 billion a year, according to a new study by the Agency for Healthcare Research and Quality.

The report provides a fuller accounting of the true cost of potentially preventable errors than had been previously published, according to the authors, William E. Encinosa, Ph.D., and Fred J. Hellinger, Ph.D., both with AHRQ's Center for Delivery, Organization, and Markets.

They looked at the comprehensive, per-episode cost of medical errors, including payments to hospitals for the initial admission and readmission, as well as payments for physicians, for outpatient services, and for prescription drugs. All cost data were included for 90 days after surgical admission.

The authors drew their analysis from the 2001-2002 MarketScan Commercial Claims and Encounter Database, which covers 5.6 million enrollees in private, employer-sponsored plans (Health Serv. Res. 2008 July 25 [doi: 10.1111/j.1475-6773.2008.00882.x

“Most papers that estimate the cost of medical errors only examine the initial hospitalization in which the medical error occurred,” they wrote. But, they added, “we find that the death rate increases by 50% over 90 days once the patient leaves the hospital.”

Postdischarge costs also are often higher than those for the initial admission, they noted. For infections, the excess payments during a 90-day episode were 28% higher.

By looking at an entire episode of care over 90 days, the researchers make a strong argument in favor of spending money on quality, Dr. Darrell A. Campbell, professor of surgery at the University of Michigan, Ann Arbor, said in an interview. “Complications and adverse events are expensive, and if you can avoid them, not only does quality go up, but costs go down.”

The case-control study examined 14 potentially preventable adverse medical events, defined by AHRQ as patient safety indicators. In all 161,004 adult, nonelderly, major surgeries were analyzed; 2.6% (4,140) of cases had at least one of the 14 preventable events, and 5.6% of those cases had additional errors.

Acute respiratory failure was the most common preventable event, which occurred in 0.9% (1,392) of all surgeries. That also was the most expensive event, at $106,000 per instance, and patients who had respiratory failure also had the highest death rate, at about 12% over the 90-day period tracked.

For all patients who had at least one preventable event, the 90-day death rate was higher at 6%, compared with 0.6% for patients who did not have a preventable event. The 90-day readmission rate was 15% for patients with a preventable event, compared with 5.5% for those without.

Overall 23% of patients who experienced potentially preventable events were readmitted, compared with 10% of those without an event. Not surprisingly, overall costs were higher for those patients with events. The 90-day cost for a surgery that included a potentially preventable event was $66,800, compared with $18,200 for a procedure that did not involve such an event.

Lengths of stay were longer, as well, at 22 days for patients with events, compared with 5 days for those without.

By extrapolating the results to the entire population of insured nonelderly adults in the United States, the authors report that 11% of 90-day postdischarge deaths and 2% of 90-day readmissions are due to the 14 potentially preventable adverse events, as are 2% ($1.5 billion) of all 90-day expenses after surgery.

This estimate might be conservative, because there are many costs that could be incurred outside of the 14 preventable errors that were assessed in the report, Dr. Campbell noted.

Going forward, it will be possible to collect stronger data on errors because hospitals are now recording whether certain preventable conditions are present on admission, he said.

ELSEVIER GLOBAL MEDICAL NEWS

Preventable surgical errors are likely costing insurers more than $1 billion a year, according to a new study by the Agency for Healthcare Research and Quality.

The report provides a fuller accounting of the true cost of potentially preventable errors than had been previously published, according to the authors, William E. Encinosa, Ph.D., and Fred J. Hellinger, Ph.D., both with AHRQ's Center for Delivery, Organization, and Markets.

They looked at the comprehensive, per-episode cost of medical errors, including payments to hospitals for the initial admission and readmission, as well as payments for physicians, for outpatient services, and for prescription drugs. All cost data were included for 90 days after surgical admission.

The authors drew their analysis from the 2001-2002 MarketScan Commercial Claims and Encounter Database, which covers 5.6 million enrollees in private, employer-sponsored plans (Health Serv. Res. 2008 July 25 [doi: 10.1111/j.1475-6773.2008.00882.x

“Most papers that estimate the cost of medical errors only examine the initial hospitalization in which the medical error occurred,” they wrote. But, they added, “we find that the death rate increases by 50% over 90 days once the patient leaves the hospital.”

Postdischarge costs also are often higher than those for the initial admission, they noted. For infections, the excess payments during a 90-day episode were 28% higher.

By looking at an entire episode of care over 90 days, the researchers make a strong argument in favor of spending money on quality, Dr. Darrell A. Campbell, professor of surgery at the University of Michigan, Ann Arbor, said in an interview. “Complications and adverse events are expensive, and if you can avoid them, not only does quality go up, but costs go down.”

The case-control study examined 14 potentially preventable adverse medical events, defined by AHRQ as patient safety indicators. In all 161,004 adult, nonelderly, major surgeries were analyzed; 2.6% (4,140) of cases had at least one of the 14 preventable events, and 5.6% of those cases had additional errors.

Acute respiratory failure was the most common preventable event, which occurred in 0.9% (1,392) of all surgeries. That also was the most expensive event, at $106,000 per instance, and patients who had respiratory failure also had the highest death rate, at about 12% over the 90-day period tracked.

For all patients who had at least one preventable event, the 90-day death rate was higher at 6%, compared with 0.6% for patients who did not have a preventable event. The 90-day readmission rate was 15% for patients with a preventable event, compared with 5.5% for those without.

Overall 23% of patients who experienced potentially preventable events were readmitted, compared with 10% of those without an event. Not surprisingly, overall costs were higher for those patients with events. The 90-day cost for a surgery that included a potentially preventable event was $66,800, compared with $18,200 for a procedure that did not involve such an event.

Lengths of stay were longer, as well, at 22 days for patients with events, compared with 5 days for those without.

By extrapolating the results to the entire population of insured nonelderly adults in the United States, the authors report that 11% of 90-day postdischarge deaths and 2% of 90-day readmissions are due to the 14 potentially preventable adverse events, as are 2% ($1.5 billion) of all 90-day expenses after surgery.

This estimate might be conservative, because there are many costs that could be incurred outside of the 14 preventable errors that were assessed in the report, Dr. Campbell noted.

Going forward, it will be possible to collect stronger data on errors because hospitals are now recording whether certain preventable conditions are present on admission, he said.

ELSEVIER GLOBAL MEDICAL NEWS