Increases in mortality, length of stay, and cost associated with hospital-acquired infections in trauma patients

Abstract

Objective: To explore the clinical impact and economic burden of hospital-acquired infections (HAIs) in trauma patients using a nationally representative database.

Design: Retrospective study.

Setting: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample.

Patients: Trauma patients.

Main outcome measures: We examined the association between HAIs (sepsis, pneumonia, Staphylococcus infections, and Clostridium difficile- associated disease) and in-hospital mortality, length of stay, and inpatient costs using logistic regression and generalized linear models.

Results: After controlling for patient demographics, mechanism of injury, injury type, injury severity, and comorbidities, we found that mortality, cost, and length of stay were significantly higher in patients with HAIs compared with patients without HAIs. Patients with sepsis had a nearly 6-fold higher odds of death compared with patients without an HAI (odds ratio, 5.78; 95% confidence interval, 5.03-6.64; P < .001). Patients with other HAIs had a 1.5- to 1.9-fold higher odds of mortality compared with controls (P < .005). Patients with HAIs had costs that were approximately 2- to 2.5-fold higher compared with patients without HAIs (P < .001). The median length of stay was approximately 2-fold higher in patients with HAIs compared with patients without HAIs (P < .001).

Conclusions: Trauma patients with HAIs are at increased risk for mortality, have longer lengths of stay, and incur higher inpatient costs. In light of the preventability of many HAIs and the magnitude of the clinical and economic burden associated with HAIs, policies aiming to decrease the incidence of HAIs may have a potentially large impact on outcomes in injured patients.

Figure 1

Study population. Ecodes indicates External Cause-of-Injury Coding; ICD-9, International Classification of Diseases, Ninth Revision; LOS, length of stay.

Figure 2

Impact on mortality of hospital-acquired infections controlling for patient demographics, mechanism of injury, injury severity, and comorbidities. CI indicates confidence interval; OR, odds ratio.

Figure 3

Impact on inpatient costs of hospital-acquired infections controlling for patient demographics, mechanism of injury, injury, comorbidities, and hospital factors (teaching status, rurality, geographic region). CI indicates confidence interval.

Figure 4

Impact on length of stay (LOS) of hospital-acquired infections controlling for patient demographics, mechanism of injury, injury, comorbidities, and hospital factors (teaching status, rurality, geographic region). CI indicates confidence interval.