Badgery-Parker T, et al. - In this cohort study and descriptive analysis of 9,330 episodes of low-value use of seven procedures, researchers measured immediate in-hospital harm related to these procedures, from 56 low-value spinal fusions to 3,963 low-value knee arthroscopies. The use of these seven procedures in those who possibly should not have had them resulted in harm to some of those patients and consumption of additional hospital resources. Moreover, this practice could potentially delay care for other patients for whom the services would be appropriate.

Methods

• This was a cohort study with a descriptive analysis, involving 225 public hospitals in New South Wales, Australia.
• Researchers conducted this study from July 1, 2014 to June 30, 2017 and used hospital admission data from these hospitals.
• They assessed 9,330 episodes involving one of seven low-value procedures.
• The measure of harm associated with low-value care was 16 hospital-acquired complications (HACs).
• They computed the percentage related to any HAC and the difference in mean length of stay for patients receiving low-value care with and without HACs, for each low-value procedure.

Results

• Overall, 225 hospitals and 9,330 episodes of low-value care were included, across which, the following procedures were associated with low rates of HACs: low-value endoscopy (4 [0.1%] episodes; 95% CI, 0.02%-0.2%), knee arthroscopy (18 [0.5%] episodes; 95% CI, 0.2%-0.7%), and colonoscopy (2 [0.3%] episodes; 95% CI, 0.0%-0.9%).
• Higher rates of HACs were reported for low-value spinal fusion (4 [7.1%] episodes; 95% CI, 2.2%-11.5%), endovascular repair of abdominal aortic aneurysm (76 [15.0%] episodes; 95% CI, 11.1%-19.7%), carotid endarterectomy (21 [7.7%] episodes; 95% CI, 5.2%-10.1%), and renal artery angioplasty (15 [8.5%] episodes; 95% CI, 5.8%-11.5%).
• For most procedures, health care–associated infection was identified as the most common HAC, and was responsible for 83 (26.3%) (95% CI, 21.8%-31.5%) of all HACs observed.
• For renal artery angioplasty, the rate of health care–associated infection was 8.4% (95% CI, 5.2%-11.4%), which was the highest observed rate.
• For all seven low-value procedures, patients with an HAC had median length of stay two times or more than that for patients without a complication.
• For example, for knee arthroscopy, patients without HACs had median length of stay of one (interquartile range [IQR], 1-1) day, which was increased to 10.5 (IQR, 1.0-21.3) days for patients with an HAC.