Reducing Infections After Heart Surgery Could Save Medicare $441 Million Per Year

Where a patient undergoes heart surgery can significantly affect their risk of infection following the procedure, with some patients facing more than double the risk of others, according to a new Michigan Medicine study.

Researchers estimate that if United States hospitals with higher infection rates for heart surgery patients could achieve outcomes similar to those with the lowest rates, they could annually prevent about 2,600 infections and reduce Medicare spending by $441 million.

The study was funded by the Agency for Healthcare Research and Quality. The findings are published in The Journal of Thoracic and Cardiovascular Surgery.

"Reducing infections after cardiac surgery is a national opportunity to improve recovery and lower Medicare spending," said co-first author Ahmad M. Hider, M.D., MPhil, a National Clinician Scholar at the University of Michigan Institute for Healthcare Policy and Innovation and a general surgery resident at the University of Colorado.

About one in five patients develop an infection in the months following heart surgery, including urinary tract infections, pneumonia and sepsis. The research team analyzed Medicare claims from nearly 240,000 cardiac surgery procedures performed at 1,000 hospitals between 2018 and 2023.

The researchers could see which patients had been diagnosed with, and treated for, different kinds of infections. The study found that hospitals with the highest infection rates experienced more than twice as many infections as the best-performing hospitals, even after accounting for differences in patients and procedures.

Hospitals with higher infection rates had higher rates of stroke, readmission and death up to six months after surgery. These hospitals also generated significantly higher Medicare spending. 

Procedures performed at hospitals in the highest infection group were associated with nearly $16,000 more in Medicare spending during the six months after surgery than those performed at hospitals in the lowest infection group. Using benchmark modeling, the research team estimated that bringing hospitals with average and high infection rates in line with the best-performing hospitals could prevent about 2,600 infections per year. It could also reduce annual Medicare spending by as much as $441 million, which equates to nearly 12% of the proposed budget for the National Heart, Lung, and Blood Institute for fiscal year 2027. 

More than one-quarter of postsurgical infections were identified when patients were readmitted to a different hospital than the one where they underwent surgery. Researchers say this finding points to another potential factor: fragmented care.

When patients receive follow up treatment across multiple healthcare systems, complications may be harder to prevent, recognize and manage.  A previous study found that better care coordination for patients undergoing coronary artery bypass grafting (CABG, or heart bypass) could save an estimated $130 million annually in hospital readmission costs.

Likosky and Pagani are members of IHPI and of the Frankel Cardiovascular Center.   University of Michigan undergraduate student Reem Nasser, a member of Michigan Medicine's Undergraduate Research Academy, served as a co-first author on the study. 

Reference:

1. https://ihpi.umich.edu/our-experts/amhider?pk_vid=23501f33c1e2d18817894757389950a6

(Newswise/AM)