tag:blogger.com,1999:blog-8066238290370557389.post5802903236432897321..comments2024-03-03T02:20:57.606-06:00Comments on Controversies in Hospital Infection Prevention: HAIs: An even bigger problem than we thought?Dan Diekemahttp://www.blogger.com/profile/10231929371552334184noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-8066238290370557389.post-52067558817524120472010-03-02T15:16:24.910-06:002010-03-02T15:16:24.910-06:00Great, thanks.Great, thanks.Chris Moorehttps://www.blogger.com/profile/00988848163035245109noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-31554674523198555312010-02-26T08:39:59.757-06:002010-02-26T08:39:59.757-06:00Thanks Chris; good question. Of course sepsis is ...Thanks Chris; good question. Of course sepsis is not always in the causal pathway between pneumonia and death. For example, patients can die of respiratory failure without sepsis. For a bacteremia outcome, it is likely best not to exclude or control for shock or sepsis, since there are few other ways to die from bacteremia. (see my first ever publication: Clin Infect Dis. 2000 Nov;31(5):1311-3)<br /><br />However, if a case had codes for both sepsis and pneumonia, Mike Eber included the cases for both the sepsis estimates and the pneumonia estimates. He summarized the costs of cases with and without overlap in the discussion section (see below). In the aggregate estimates of costs, he used the patient-level costs of sepsis cases times the number of sepsis cases and added to this the patient-level costs of pneumonia cases recalculated to exclude sepsis cases times an estimate of the number of pneumonia cases excluding sepsis cases. (you have to read that at least twice before it sinks in)<br /><br />From the Discussion Section: Among invasive surgery patients, for example, sepsis associated with pneumonia had attributable mean LOS, hospital costs, and in-hospital mortality of 23.7 days, $80 000, and 27.9%, respectively, whereas these outcomes were 10.3 days, $30 800, and 18.7%, respectively, for cases of sepsis not associated with pneumonia. Outcomes in pneumonia cases that were not also coded as sepsis cases in the results were 12.5 days, $41 500, and 8.1%, respectively.Eli Perencevichhttps://www.blogger.com/profile/05131155100606411030noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-73333872214823586222010-02-25T10:19:21.260-06:002010-02-25T10:19:21.260-06:00How do we not interpret pneumonia deaths as deaths...How do we not interpret pneumonia deaths as deaths from sepsis? How many sepsis cases were due to HAP? Are these cases defined as sepsis or pneumonia cases?<br /><br />Whatever the case, the data are compelling.<br /><br />Thanks in advance for the clarification.Chris Moorehttps://www.blogger.com/profile/00988848163035245109noreply@blogger.com