Costs associated with health care-associated infections in cardiac surgery

Giampaolo Greco, Wei Shi, Robert E. Michler, David O. Meltzer, Gorav Ailawadi, Samuel F. Hohmann, Vinod H. Thourani, Michael Argenziano, John H. Alexander, Kathy Sankovic, Lopa Gupta, Eugene H. Blackstone, Michael A. Acker, Mark J. Russo, Albert Lee, Sandra G. Burks, Annetine C. Gelijns, Emilia Bagiella, Alan J. Moskowitz, Timothy J. Gardner

Research output: Contribution to journalArticlepeer-review

56 Scopus citations


Background Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited.

Objectives This research was designed to determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery.

Methods Prospectively collected data from a multicenter, observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, with adjustments for patient demographics, clinical history, baseline laboratory values, and surgery type.

Results Among 4,320 cardiac surgery patients (mean age: 64 ± 13 years), 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%), and Clostridium difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions; among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAIs was, on average, nearly threefold that of readmissions not related to HAIs.

Conclusions Hospital cost, LOS, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. (Management Practices and the Risk of Infections Following Cardiac Surgery; NCT01089712).

Original languageEnglish
Pages (from-to)15-23
Number of pages9
JournalJournal of the American College of Cardiology
Issue number1
StatePublished - 6 Jan 2015


  • Health care-associated
  • costs length of stay
  • infection hospital


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