Abstract: In a Little While: Anticipating Changes in Bundled Payments for the Treatment of Patients with Acute, Life-Threatening Dermatologic Emergencies, through Prevention of Healthcare Associated Infections (Plastic Surgery The Meeting)

Sunday, September 25, 2016: 11:10 AM

Steven Junior Hermiz, MD , Surgery, The University of South Carolina, Columbia, Columbia, SC

Paul Diegidio, MD , Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, Chapel Hill, NC

Shiara Ortiz-Pujols, MD , Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, chapel Hill, NC

Roja Garimella, BS , Division of Plastic and Reconstructive Surgery, The University of North Carolina, Chapel HIll, NC

David Jay Weber, MD, MPH , Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, Chapel Hill, NC

David Van Duin, MD, PhD , Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, Chapel Hill, NC

C. Scott Hultman, MD, MBA , Division of Plastic and Reconstructive Surgery, The University of North Carolina, Chapel Hill, NC

Presentation PDF file

Purpose: Patients admitted to a burn center suffering from the Stevens-Johnson syndrome to Toxic Epidermal Necrolysis (SJS-TEN) spectrum are typically thought of as having a high hospital morbidity and mortality. Little is known about patients admitted to a burn center suffering from non-bullous Skin Disorders (SD). This group includes severe rashes, non-healing wounds, erythema multiforme, and unknown skin lesions requiring hospitalizations. We compared these two group’s costs, mortality, and the effect of Healthcare-Associated Infections (HAI) on outcomes to better define this patient population.

Methods: A post-hoc analysis of prospectively collected data was performed on 445 patients who had a diagnosis of a dermatologic condition requiring hospitalization who were admitted to our 36 bed ABA accredited burn center over the last 10 years. These charts, divided into SJS-TEN and SD, were cross-referenced with the hospital wide infectious control database to identify patients who suffered from HAIs that met the CDC National Healthcare Safety Network surveillance definitions. These two groups were then compared using 2-tailed t-test, or chi-square, for nominal and categorical variables, respectively.

Results: There were 316 patients in the SD group and 129 in the SJS-TEN. SD patients had significantly higher ICU and ventilator days, compared to SJS-TENs. When HAI were present, both groups had a significant increase in cost, and SJS-TENs patients had increased mortality. The two cohorts did not differ, in terms of %TBSA, overall mortality, or incidence of HAI. SD patients were also significantly more likely to be female, and were more likely to have a UTI; contrasted to a CLABSI or CAUTI in the SJS-TENs group.

Conclusion: Clinicians taking care of non-SJS-TEN Skin Disorder patients in burn centers should be aware of a high mortality rate, susceptibility to similar HAI especially, and the potential for a prolonged ICU stay and high number of ventilator days. With bundled payments on the horizon, health care facilities may not be able to cover cost of care, if HAI occur in SD or SJS-TEN patients.

29554 In a Little While: Anticipating Changes in Bundled Payments for the Treatment of Patients with Acute, Life-Threatening Dermatologic Emergencies, through Prevention of Healthcare Associated Infections