IN FECTIO N CO NTRO L
Readmission Adds to Necrotizing Soft Tissue Infection Disease Burden By JENNA BASSETT, PhD
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atients with necrotizing soft tissue infections (NSTIs) experience greater disease burden with hospital readmissions, according to the results of a new analysis. Patients with NSTIs have a high risk for unplanned hospital readmission, but the factors that influence readmission are poorly understood. Researchers from Tulane University School of Medicine, in New Orleans, retrospectively investigated the incidence and factors associated with unscheduled readmission among patients with NSTIs. Of the 82,738 patients diagnosed with necrotizing fasciitis, gas gangrene or Fournier’s syndrome, 30.3% were readmitted within 90 days. Of the readmitted patients, 79.8% had unscheduled readmission. The most common causes of readmission were septicemia, cellulitis, abscess and postoperative infection. Patients with unplanned readmission were generally older, female, more likely to be diabetic, had higher Charlson Comorbidity Index scores and were less likely to be obese. In a multivariate analysis, factors associated with readmission were prolonged versus short length of stay, Medicaid versus Medicare as the primary payor, and leaving against medical advice. No demographic variables, clinical characteristics or interventions were associated with readmission. Of the readmitted patients, 3.8% died during their hospitalization. Age older than 65 years and fragmentation of care caused by readmission to a different hospital were independently associated with mortality, while being obese favored survival. Presenting author Eman Toraih, MD, an associate professor of medical genetics at Tulane University School of Medicine, said clinicians need to ensure that discharged patients have the resources they need so they will not require readmission. “This may mean ensuring that they do not only have a prescription for antibiotics, but also the means and resources to obtain antibiotics
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minimize inflated charges. But for the private practice surgeons who have faced declining reimbursement rates for years, a further reduction in reimbursement may mean a death sentence for their business. The outcomes of arbitration also may affect health insurance premiums, but it’s unclear in which direction. The Congressional Budget Office estimates that the federal law will reduce commercial insurance premiums by between 0.5% and 1%, 20
OR Management News • June 2021
and take them as directed. In addition, these patients often have complicated wound care needs, and we must ensure that those needs are met after discharge.” In the future, Dr. Toraih envisions the implementation of formalized protocols for patients being discharged after NSTIs. “These protocols may need to be directed toward patients that are at high risk of readmission, such as those that had a prolonged hospital stay. These protocols may help with access to antibiotics and wound care needs. In addition, these protocols should provide clear lines of communication to the discharging care team in case the patient has questions or problems after discharge. This may help prevent fragmentation of care in another hospital.” Dr. Toraih added: “Our vision is to apply artificial intelligence to design mobile application or online risk assessment tools to predict the probability of readmission and complications for each ■ patient.”
if insurers win in arbitration. Alternatively, some experts worry that premium costs could rise if insurers lose in arbitration. The second uncertainty is how exactly the federal law will interact with existing state laws. The answer, Dr. Bailey said, depends on whether a person has a federalregulated plan or a fully insured state-regulated plan. For the 18 states that have comprehensive surprise billing legislation, the federal law defers to the state regulations for fully insured plans. However, because states cannot regulate employer-based plans,
which fall under ERISA, the federal regulations take precedence. State laws will also remain primary when state-level requirements extend beyond those detailed in the new federal law. “In states with their own laws, there is a potential for very different outcomes on claims for similar services depending on whether the patient’s plan is subject to state or federal regulations,” Dr. Bailey said. “This could create confusion for the out-of-network surgeon when determining what steps can be taken regarding a payment from an insurer.” ■
