Never events after hepatopancreatobiliary operations - 06/12/18
Abstract |
Background |
In 2008, the Centers for Medicare & Medicaid Services (CMS) terminated reimbursement for never events (NE). NE in hepatopancreatobiliary (HPB) patients are poorly understood. We investigated the incidence and effects of NE in this population.
Methods |
We queried the Nationwide Inpatient Sample (NIS) to identify all patients who underwent HPB operations, before (Cohort A: 2003–2007) and after (Cohort B: 2008–2011) the CMS mandate. We compared incidence, demographics, outcomes and predictors of NE.
Results |
We identified 57,436 HPB patients, of whom 624 (1.1%) incurred a NE. NE occurred more frequently after pancreas (1.4%) than liver (0.9%) and biliary (0.8%) operations (P < .01). The most common NE were falls (43%) and vascular-catheter-associated infections (28%). Paralysis, chronic renal insufficiency, metastatic cancer, altered mental status, weekend admissions and non-elective procedures were correlated with NE. An overall increase in NE was observed between cohorts.
Discussion |
HPB surgery patients who sustain NE have significantly worse outcomes, and despite CMS policy changes, NE incidence has not improved. Further efforts to combat NE in HPB surgery patients are necessary to decrease their likelihood.
Le texte complet de cet article est disponible en PDF.Highlights |
• | CMS terminated reimbursement for Never Events (NE) in 2008 but effect on practice for HPB patients did not improve. |
• | Patients undergoing HPB operations are at high risk for NE with highest incidence after pancreatic operations. |
• | Majority of NE's were falls or vascular catheter associated infections. |
• | Chronic renal insufficiency, metastatic cancer, weekend admission & non-elective procedures are associated with NE. |
Plan
Vol 216 - N° 6
P. 1129-1134 - décembre 2018 Retour au numéro
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