Risk of readmissions, mortality, and hospital-acquired conditions across hospital-acquired pressure injury (HAPI) stages in a US National Hospital Discharge database

Abstract

Pressure injuries are one of the most common and costly complications occurring in US hospitals. With up to 3 million patients affected each year, hospital-acquired pressure injuries (HAPIs) place a substantial burden on the US healthcare system. In the current study, US hospital discharge records from 9.6 million patients during the period from October 2009 through September 2014 were analysed to determine the incremental cost of hospital-acquired pressure injuries by stage. Of the 46 108 patients experiencing HAPI, 16.3% had Stage 1, 41.0% had Stage 2, 7.0% had Stage 3, 2.8% had Stage 4, 7.3% had unstageable, 14.6% had unspecified, and 10.9% had missing staging information. In propensity score-adjusted models, increasing HAPI severity was significantly associated with higher total costs and increased overall length of stay when compared with patients not experiencing a HAPI at the index hospitalisation. The average incremental cost for a HAPI was $21 767. Increasing HAPI severity was significantly associated with greater risk of in-hospital mortality at the index hospitalisation compared with patients with no HAPI, as well as 1.5 to 2 times greater risk of 30-, 60-, and 90-day readmissions. Additionally, increasing HAPI severity was significantly associated with increasing risk of other hospital-acquired conditions, such as pneumonia, urinary tract infections, and venous thromboembolism during the index hospitalisation. By preventing pressure injuries, hospitals have the potential to reduce unreimbursed treatment expenditures, reduce length of stay, minimise readmissions, prevent associated complications, and improve overall outcomes for their patients.

Keywords: costs; healthcare resource utilization; hospital acquired pressure injuries; mortality.

FIGURE 1

Adjusted mean total costs overall and among patients with an ICU stay. Generalised linear models with a gamma distribution and log link were used, and adjusted for propensity score, provider area (midwest, west, south, northeast), and discharge status (expired; home; SNF, Rehab, ICF or long term care; transferred to acute care; other). In‐hospital mortality is included as part of the discharge status variable (“expired”), so was not included separately as an adjustment variable. Error bars are 95% confidence intervals. Error bars are not displayed for the non‐HAPI group, as they are extremely small

FIGURE 2

Adjusted mean LOS overall and among patients with an ICU stay. Adjusted for propensity score, provider area (midwest, west, south, northeast), and discharge status (expired; home; SNF, Rehab, ICF or long term care; transferred to acute care; other). In‐hospital mortality is included as part of the discharge status variable (“expired”), so was not included separately as an adjustment variable. Error bars are 95% confidence intervals. Error bars are not displayed for the non‐HAPI group, as they are extremely small