Among 7 low-value care interventions assessed, harm is being caused to some patients who do not need these interventions, leading to increased costs of hospital stay and “consuming additional hospital resources.” Data were published in JAMA Internal Medicine.
Researchers used descriptive analysis to quantify the downstream consequences of low-value care interventions for both patients and the healthcare system in New South Wales, Australia. A total of 9330 episodes in 225 public hospitals from July 2014 through June 2017 were evaluated: 3689 episodes of endoscopy for dyspepsia in people younger than age 55; 3963 episodes of knee arthroscopy for osteoarthritis or meniscal tears; 665 episodes of colonoscopy for constipation in people younger than age 50; 508 episodes of endovascular repair of abdominal aortic aneurysm in asymptomatic, high-risk patients; 273 episodes of carotid endarterectomy in asymptomatic, high-risk patients; 176 episodes of renal artery angioplasty; and 56 episodes of spinal fusion for uncomplicated low back pain. Sixteen hospital-acquired complications were used as measures of the harm associated with low-value care interventions that should not have been performed on patients.
Rates of hospital-acquired complications were low for colonoscopy (0.3%;, 95% CI, 0.0%-0.9%), low-value endoscopy (0.1%;, 95% CI, 0.02%-0.2%), and knee arthroscopy (0.5%;, 95% CI, 0.2%-0.7%), but higher for low-value spinal fusion (7.1%;, 95% CI, 2.2%-11.5%), renal artery angioplasty (8.5%;, 95% CI, 5.8%-11.5%), carotid endarterectomy (7.7%;, 95% CI, 5.2%-10.1%), and endovascular repair of abdominal aortic aneurysm (15.0%;, 95% CI, 11.1%-19.7%).
The most common hospital-acquired complication for most procedures was infection, accounting for 26.3% (95% CI, 21.8%-31.5%) of all hospital-acquired complications observed and ranking as most prevalent in renal artery angioplasty at 8.4% (95% CI, 5.2%-11.4%). Patients with hospital-acquired complications had median lengths of stay 2 or more times longer than those without hospital-acquired complications. Investigators give the example of knee arthroscopy, for which the median length of stay was 1 day with no hospital-acquired complications (interquartile range [IQR], 1-1) but 10.5 days (IQR, 1.0-21.3) with a hospital-acquired complication.
Limitations of this study include restricting data on harm to the low-value care episode as well as restricting data on harm to a predetermined set of possible complications.
The investigators concluded that more research is warranted. Furthermore, they concluded, “Although we restricted this study to 7 low-value procedures and measured only some immediate in-hospital complications associated with these procedures, we found high rates of harm in some cases, with substantial additional lengths of stay. The full burden of low-value care for patients and the healthcare system is yet to be quantified.”
Several authors report conflicts of interest. Please refer to reference for a complete list of disclosures.
Badgery-Parker T, Pearson SA, Dunn S, Elshaug AG. Measuring hospital-acquired complications associated with low-value care [published online February 25, 2019]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.7464