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Calculating the Many Burdens of Post-Operative Pulmonary Complications (PPCs)

A clinician places his hand on the shoulder of a patient in an ICU bed

In the ICU, It Can Seem Like Everything Is Elevated

Acuities. Complexity. Risk levels. Unplanned readmissions. And certainly costs.

This high-stakes setting presents unique challenges to clinical and financial outcomes alike — and post-operative pulmonary complications (PPCs) are among the top offenders. In this article, we will dive into the clinical need to address these challenges, the financial burden you may not realize you are already paying and, most importantly, proven strategies to reduce these costly complications.

What are Common Post-Operative Pulmonary Complications?

Some of the most common pulmonary/lung complications after surgery are:

  • Reintubation15
  • Acute respiratory failure15
  • Pulmonary edema15
  • Pneumonia15
  • Atelectasis15
  • Pulmonary embolism14

 

The Clinical Burden of Pulmonary Complications

PPCs are common and dangerous. Incidence estimates range from 3-7.9%1,2 after general surgeries, with higher rates for these problems after lung surgeries.3 They are associated with long periods of immobility (all too common in the ICU), and they impact patient stability and outcomes in ways that are both immediate and far-reaching:

 

Length of Stay (LOS)

PPCs have been shown to increase length of stay by 13-17 days4,5,6

Mortality

14-30% of patients experiencing PPCs die within 30 days after a major surgery (compared to only 0.2-3% of patients without PPCs).17,18,19,20,21,22

Readmission & Adverse Discharge Disposition

Respiratory and cardiac conditions are the most common precipitating causes of ICU readmissions (30-70%).7 Furthermore, reintubation, pulmonary edema and atelectasis after surgery are known predictors of adverse discharge dispositions (in-hospital mortality or discharge to a nursing home).8

 

The Financial Burden of Pulmonary Complications

PPCs also impact hospitals’ financial outcomes. Additional care, longer stays in the ICU and CMS penalties are just a few reasons why.

 

Cost of Care

Reintubation is associated with a higher risk of ventilator-associated pneumonia (VAP),11,12 which has been linked to longer ICU LOS and $20-80,000 higher costs of care.13

Reduced Reimbursements

Respiratory complications are leading causes of unplanned ICU readmissions — and ICU readmissions have twice the average hospital LOS.9 Additionally, excess readmissions can lead to lower reimbursements from CMS.10

Uncovering Your True Financial Burden

What are post-operative pulmonary complications already costing your hospital? Uncover your true burden with this interactive calculator. Simply enter your own clinical data like staffed beds, average LOS, surgical case volume, etc., and the tool will estimate your actual costs.

Take Action Against Post-operative Pulmonary Complications with In-Bed Therapy and Early Mobility

In-bed pulmonary therapy has been shown to be safe, feasible and effective in the ICU. In fact, a study conducted at the Cleveland Clinic with 637 neurology ICU patients found that a progressive mobility program (featuring in-bed pulmonary therapy) led to:3

  • 36% reduction in LOS
  • 33% reduction in overall hospital LOS
  • 46% reduction in ventilator days
  • 30% reduction in overall hospital costs

Meet the Progressa Smart+ Bed

The Progressa Smart+ Bed provides in-bed therapies and mobility support to help reduce pulmonary complications and other common side-effects of immobility.

Meet the Progressa Smart+ Bed

Percussion & Vibration Therapy

Chest physiotherapy with in-bed percussion & vibration therapies are designed to facilitate mucous mobilization. Caregivers can deliver this in-bed therapy with the touch of a few buttons.

Continuous Lateral Rotation Therapy (CLRT)

Full-body CLRT is designed to assist in mobilizing mucus secretions, resulting in a more comfortable, therapeutic experience and faster recovery.

Progressive Mobility Support

Flexible frame options help patients move safely and easily. The FullChair position with chair egress supports patients as they work to stand, and a three-mode bed exit alarm helps caregivers prevent patient falls.

The Burdens of Post-Operative Pulmonary Complications are Significant — But Not Inevitable

With technology tailored for the elevated risks, complexities and stakes in your ICU, you can make an impact on both clinical and financial outcomes. We can help. Learn more about the Progressa Smart+ Bed or reach out to your Hillrom/Baxter representative today.   

References
  1. Mazo V, Sabaté S, Canet J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology 2014; 121:219–231.
  2. Johnson RG, Arozullah AM, Neumayer L, et al. Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007; 204:1188–1198.
  3. Kim ES, Kim YT, Kang CH, et al. Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:1317–1326.
  4. VA Lawrence, SG Hilsenbeck, CD Mulrow, R Dhanda, J Sapp, CP Page. Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery. J Gen Intern Med, 10 (1995), pp. 671-678.
  5. PR Smith, MA Baig, V Brito, F Bader, MI Bergman, A Alfonso. Postoperative pulmonary complications after laparotomy. Respiration, 80 (2010), pp. 269-274
  6. OO Nafiu, SK Ramachandran, R Ackwerh, KK Tremper, DA Campbell Jr, JC Stanley. Factors associated with and consequences of unplanned post-operative intubation in elderly vascular and general surgery patients. Eur J Anaesthesiol, 28 (2011), pp. 220-224
  7. Rosenberg AL, Watts C. Chest. 2000;118:492-502.
  8. Sonny A, Grabitz SD, Timm FP, et al. Impact of postoperative respiratory complications on discharge disposition, mortality, and re-admissions. ASA Abstr 2016. A5016.
  9. Rosenberg AL, Watts C. Chest. 2000;118:492-502.
  10. Readmissions reduction program. CMS website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html.
  11. Torres A, et al. Am J Respir Crit Care Med. 1995;152:137-141.
  12. Elward AM, et al. Pediatrics. 2002;109:758-764.
  13. AHRQ 2017 HAC Cost including VAP
  14. Temgoua MN, Tochie JN, Noubiap JJ, Agbor VN, Danwang C, Endomba FTA, Nkemngu NJ. Global incidence and case fatality rate of pulmonary embolism following major surgery: a protocol for a systematic review and meta-analysis of cohort studies. Syst Rev. 2017 Dec 4;6(1):240. doi: 10.1186/s13643-017-0647-8. PMID: 29202836; PMCID: PMC5716368.
  15. Ruscic, Katarina J.a; Grabitz, Stephanie D.a; Rudolph, Maíra I.a; Eikermann, Matthiasa,b. Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement. Current Opinion in Anaesthesiology: June 2017 - Volume 30 - Issue 3 - p 399-408 doi: 10.1097/ACO.0000000000000465
  16. Wu X, Li Z, Cao J, Jiao J, Wang Y, Liu G, Liu Y, Li F, Song B, Jin J, Liu Y, Wen X, Cheng S, Wan X. The association between major complications of immobility during hospitalization and quality of life among bedridden patients: A 3 month prospective multi-center study. PLoS One. 2018 Oct 12;13(10):e0205729. doi: 10.1371/journal.pone.0205729. PMID: 30312330; PMCID: PMC6185860.
  17. E Sundman, H Witt, R Olsson, O Ekberg, R Kuylenstierna, LI Eriksson. The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans. Anesthesiology, 92 (2000), pp. 977-984
  18. SK Ramachandran, OO Nafiu, A Ghaferi, KK Tremper, A Shanks, S Kheterpal. Independent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery. Anesthesiology, 115 (2011), pp. 44-53
  19. DJ Kor, DO Warner, A Alsara, et al. Derivation and diagnostic accuracy of the surgical lung injury prediction model. Anesthesiology, 115 (2011), pp. 117-128
  20. PR Smith, MA Baig, V Brito, F Bader, MI Bergman, A Alfonso. Postoperative pulmonary complications after laparotomy. Respiration, 80 (2010), pp. 269-274
  21. FA McAlister, K Bertsch, J Man, J Bradley, M Jacka. Incidence of and risk factors for pulmonary complications after non-thoracic surgery. Am J Respir Crit Care Med, 171 (2005), pp. 514-517
  22. SF Khuri, WG Henderson, RG DePalma, C Mosca, NA Healey, DJ Kumbhani. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg, 242 (2005), pp. 326-341