Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia

Health care-associated infections (HAIs) affect an estimated 1.7 million hospitalizations each year in the United States but the costs and impact of these infections is not well studied. This study, using a national database of hospital discharge records from 1998-2006, attempted to identify sepsis and pneumonia HAIs and examine the hospital lengths of stay, hospital costs and mortality associated with the infections. The models controlled for patient diagnosis, procedures, comorbidities, demographics and length of stay before infection.

Key Findings

  • Health care-associated sepsis and/or pneumonia was identified in 557,967 hospitalizations of approximately 59 million included hospitalization records. Infections were identified in 40 states.
  • Patients who had invasive surgery and contracted sepsis while in the hospital spent 10.9 more days in the hospital, cost $32,900 more and had an attributable crude mortality rate of 19.5 percent, compared to similar control patients. Patients who contracted pneumonia spent 14 days more, cost $46,400 more and had a mortality rate of 11.4 percent.
  • Estimates related to the subset of patients who had elective invasive surgery were even higher.
  • HAI-attributable lengths of stay and hospital costs for patients who did not have invasive surgery were 40 percent lower than for those who did have such surgery.
  • Estimates did not vary much over time during the 1998-2006 sample period.

Although the data used in this analysis is large, geographically diverse and includes a broader array of hospitals, the study is limited by its reliance on administrative records which contain limited clinical information and may lead to underestimates. However, extrapolating from the study analysis, the commentary estimates the costs of sepsis and pneumonia HAIs in 2006 alone to be 48,000 deaths, $8.1 billion in hospital costs and 2.3 million hospital days. For several reasons, including the current insurance system which denies reimbursement for HAIs, it is difficult to know whether insurers or hospitals are bearing more of the burden of HAIs. However, the commentary suggests it is time to look at incentives and regulatory options to reduce the incidence of these clinically and economically costly infections.