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10/8/2003

Medical Injuries Blamed for 30K Deaths, $9B in Charges

Donna Young

Medical injuries in hospitals are responsible for 2.4 million extra days of hospitalization for patients, $9.3 billion in excess charges, and 32,591 deaths in the United States annually, researchers reported today in the Journal of the American Medical Association (JAMA).

The most serious event, researchers found, was postoperative sepsis—resulting in almost 11 extra days of hospitalization, $57,727 in extra charges per patient, and an almost 22 percent higher risk that a patient would die.

Postoperative wound ruptures—the second leading event—resulted in almost 10 extra days and $40,323 in extra charges per patient.

Obstetric trauma and anesthesia complications had the lowest rate of extra hospital stays and charges, researchers said, but added that patients with these events "undoubtedly experienced other significant outcomes that were not captured," in the reported data.

Researchers analyzed 18 specific types of medical injuries using 7.45 million discharge abstracts from 994 acute care hospitals in 28 states—about 20 percent of acute care facilities in the United States—to assess excess length of stay, charges, and deaths attributable to medical injuries during hospitalization.

The discharge data used for the study came from the 2000 Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS), which includes 15 International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis codes, that was developed by the Agency for Healthcare Research and Quality (AHRQ).

The limited research on medical injuries has primarily relied on medical record abstraction, the study noted.

But transforming records into useful research data on medical injuries is time-consuming, expensive, and requires researchers to have specific knowledge and skills in medical context and methods.

Alternative research methods include using mandatory and voluntary reports, drug safety and nosocomial infection surveillance, and medical malpractice data, but that data are often difficult to obtain, researchers argued.

On the contrary, administrative data are regularly collected and maintained for reimbursement and management purposes, are computer readable, inexpensive to analyze, longitudinal, and cover large populations, researchers noted.

But the study's authors acknowledged that the reliability and validity of AHRQ's patient safety indicators used to screen the administrative data depend on the accuracy and completeness of ICD-9-CM coding.

"There may be various coding errors" researchers said. The study's authors also confessed that the ICD-9-CM coding system was not designed to identify medical injuries and could not be "clinically precise for this purpose."

Although the study "adds little to the scant knowledge about the national prevalence of various types of medical injuries," researchers said, "it provides significant insights into the adverse effects of selected medical injuries on patients and health care resources."