Nosocomiale Infecties in België, deel II: Impact op Mortaliteit ... - KCE

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20 Nosocomial Infections – Mortality and Costs KCE reports 102 Table 3.1: Charlson score: Scoring the co-morbidity index from secondary diagnoses table from D’Hoore 59 3.2.6 Analyses • The time to infection: the LOS of controls must be at least equal to the time to diagnosis of the infection (the number of days between admission and start of NBSI) (time). To allow for a certain incubation period, a gap of 2 days has also been allowed (time2) Characteristics that can be influenced by complications (admission + discharge) • Severity of APR-DRG: as assessed by the grouper: 1, 2, 3, 4 (DRG-sev). The severity of the APR-DRG takes into account all secondary diagnoses and complications which occurred during the hospitalisation. • Stay with a passage in a ICU unit: yes or no (ICU) Additional LOS and costs attributable to NBSI were estimated in a matched cohort study (1 case: 1 control). Per design, the 2 first matching factors are the hospital and the APR-DRG. Next, a series of different possible matching factors were examined in order to study the feasibility of the matching and the influence of the matching criteria on the estimate of attributable LOS. The difference in outcome (LOS and Cost) for each case-control pair was then computed. The additional LOS and cost attributable to NBSI, and corresponding 95% CI, was computed based on these differences. A paired t-test was used to test the hypothesis that the attributable LOS and cost are not null. To test whether the additional LOS and costs were consistent across different baseline characteristics, subgroup analyses were performed, and the interaction between the additional LOS and costs and the subgroup were tested in an ANOVA model. The results of the 1:1 matching procedure were also compared to the results of the 1:4 matching procedure (allowing from a variable number of controls per case, from 1 to a maximum of 4 controls, data not shown).
KCE reports 102 Nosocomial Infections – Mortality and Costs 21 3.3 RESULTS 3.3.1 Data received 3.3.1.1 Participating Hospitals in Study Of the 22 hospitals which participated during the full year 2003 to the surveillance of nosocomial bloodstream infections, 20 hospitals accepted to participate to the study and did send their data within the planned timeframe to the Technical Cell (closing date 15 July 2006). For a technical reason (a problem of software version), the data from 1 hospital could not be used. Thus the present report is based on data from 19 hospitals. The list of participating hospitals is in appendix. 3.3.1.2 Number of Nosocomial Bloodstream Infections A total of 3302 bloodstream infections were reported to the NSIH during the year 2003 by the 19 participating hospitals. Some of these infections started within 2 days of hospital admission, and are therefore considered as non nosocomial. A total of 2762 corresponding stays (83.6%) only could be retrieved from the Minimal Clinical Data (MCD) database. One possible explanation for the incompleteness of the linkage is that the MCD 2003 database is based on patients discharged in 2003, while the NBSI database contains also patients infected in 2003 but discharged in 2004. From the 2762 linked infections, 787 were declared within 2 days of hospital admission, and were excluded from analysis. The link was made with the Minimal Financial Data (MFD), and other checks were performed to verify the consistency of the data. Finally, 1839 stays were available for the cost analysis. Table 3.2: Participation to the Study Hospitals participating to the NSIH full year 2003 surveillance 22 Hospitals participating to this study 19 All Bloodstream infections reported to NSIH in 2003 3302 Corresponding stays retrieved in Minimal Clinical Database (MCD) 2762 Non nosocomial bloodstream infections 787 Nosocomial Bloodstream infections 1975 Nosocomial Bloodstream Infection with Cost data (Minimal Financial Data) Available 1839 The 1839 stays with a NBSI are distributed across 254 different APR-DRG. The 10 most common APR-DRGs are given in Table 3.3 (all data are in appendix). The three most common APR-DRGs are surgical (tracheotomy, bowel procedures and procedures not related to the diagnosis of admission). While it was confirmed that these infections were not the reason for admission, the fact that 51 stays (2.7%) are classified in the APR-DRG Septicemia brings some doubts to the coding of these hospitalisations. This coding problem was not restricted to a few hospitals. N
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Nosocomiale Infecties in België, deel II: Impact op Mortaliteit ... - KCE

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