National estimated costs of never events following radical prostatectomy

To examine the Centers for Medicare and Medicaid Services, which since 2008 has identified and not reimbursed 10 common postoperative complications deemed "never events" or hospital-acquired conditions (HACs). Prostate cancer, the most frequent cancer among U.S. men, is most often treated with radical prostatectomy (RP). Therefore, its complications in total may represent significant costs to hospitals and providers if not reimbursed. We evaluated the potential effect of these unreimbursed HACs following RP on clinical outcomes and costs.

Using the Nationwide Inpatient Sample, we selected a weighed, national, estimated sample of 451,707 men with prostate cancer who underwent RP between 2002 and 2009. Baseline sociodemographic and hospital characteristics are described. We calculated estimated frequencies and costs of HACs and the predictors of in-hospital mortality, prolonged length of stay, and increased total hospital costs.

Overall, HACs were infrequent at 0.08%, with pressure ulcer development (0.02%) and foreign object retained at surgery (0.02%) being the most common. HAC occurrence was not affected by hospital teaching status or surgical volume, but larger hospital size was related to more HACs. Those experiencing an HAC were much more likely to have a prolonged length of stay (odds ratio = 6.68, 95% CI: 5.34-8.36) and increased hospital costs (odds ratio = 5.03, 95% CI: 4.05-6.24). HACs after RP cost an estimated nearly $1 million annually in the United States.

In a robust sample of patients who underwent RP in the United States, HACs were very uncommon and contributed approximately $1 million in additional expenditures. As the U.S. government continues to expand quality improvement programs and develop incentives to avoid complications, efforts to monitor unnecessary complications should continue as well.