Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization

JAMA. 2003 Oct 8;290(14):1868-74. doi: 10.1001/jama.290.14.1868.


Context: Although medical injuries are recognized as a major hazard in the health care system, little is known about their impact.

Objective: To assess excess length of stay, charges, and deaths attributable to medical injuries during hospitalization.

Design, setting, and patients: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) were used to identify medical injuries in 7.45 million hospital discharge abstracts from 994 acute-care hospitals across 28 states in 2000 in the AHRQ Healthcare Cost and Utilization Project Nationwide Inpatient Sample database.

Main outcome measures: Length of stay, charges, and mortality that were recorded in hospital discharge abstracts and were attributable to medical injuries according to 18 PSIs.

Results: Excess length of stay attributable to medical injuries ranged from 0 days for injury to a neonate to 10.89 days for postoperative sepsis, excess charges ranged from 0 dollar for obstetric trauma (without vaginal instrumentation) to 57 727 dollars for postoperative sepsis, and excess mortality ranged from 0% for obstetric trauma to 21.96% for postoperative sepsis (P<.001). Following postoperative sepsis, the second most serious event was postoperative wound dehiscence, with 9.42 extra days in the hospital, 40 323 dollars in excess charges, and 9.63% attributable mortality. Infection due to medical care was associated with 9.58 extra days, 38 656 dollars in excess charges, and 4.31% attributable mortality.

Conclusion: Some injuries incurred during hospitalization pose a significant threat to patients and costs to society, but the impact of such injury is highly variable.

Publication types

  • Evaluation Study

MeSH terms

  • Diagnosis-Related Groups
  • Health Services Research
  • Hospital Charges / statistics & numerical data*
  • Hospital Mortality*
  • Humans
  • International Classification of Diseases
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data*
  • Medical Errors / economics
  • Medical Errors / statistics & numerical data*
  • Outcome Assessment, Health Care
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology
  • Quality Indicators, Health Care
  • Quality of Health Care / statistics & numerical data*
  • United States / epidemiology
  • United States Agency for Healthcare Research and Quality