Health care-associated infections are associated with increased length of stay and cost but not mortality in children undergoing cardiac surgery

Abstract

Introduction: Health care-associated infections (HAIs) increase mortality, length of stay, and cost in hospitalized patients. The incidence of and risk factors for developing HAIs in the pediatric population after cardiac surgery have been studied. This study evaluates the impact of HAIs on length of stay, inpatient mortality, and cost of hospitalization in the pediatric population after cardiac surgery.

Methods: The Kids' Inpatient Database was queried for analysis. Patients under 18 years of age who underwent cardiac surgery from 1997 to 2012 were included. HAIs were defined as central line-associated blood stream infections, catheter-associated urinary tract infections, ventilator-associated pneumonias, and surgical wound infections. Univariate analysis compared admissions with and without a HAI. Next, regression analysis was done to determine patient factors independently associated with a HAI, and to determine what specific HAIs were independently associated with our primary outcomes.

Results: In total 46 169 admissions were included, 773 (1.6%) of which had a HAI. Regression analysis showed younger age (P < .001), heart failure (OR 1.2, 95% CI 1.1-1.4, P = .03), and acute kidney injury (AKI; 2.7, 2.0-3.6, P < .001), among others were all independently associated with a HAI. The presence of HAI was associated with increased length of stay (median 29 vs 6 days, P < .001), total cost (median $271 884 vs $88 385, P < .001), and inpatient mortality (6.1% vs 2.5%, P < .001) by univariate analysis. Regression analysis demonstrated that each HAI were independently associated with increased length of stay and increased total charges for the hospital stay. However, HAI, was not associated with increased mortality after regression analysis.

Conclusions: The incidence of HAIs in this analysis was low (1.6%) but contributed significantly to length of stay and cost. No individual HAI was associated with increased mortality. Potential modifiable risk factors include age and prevention of AKI.

Keywords: catheter-associated urinary tract infection; central line-associated blood stream infection; health care-associated infection; pediatric cardiac surgery; surgical wound infection; ventilator-associated pneumonia.