"Never events": Centers for medicare and medicaid services complications after radical cystectomy

Objective: To describe "never event" (NE) complications after radical cystectomy. Materials and Methods: The Centers for Medicare and Medicaid Services has denied reimbursement for 10 hospital-acquired conditions that were deemed "reasonably preventable." These NEs do not take into consideration pre-existing risk factors that make patients more susceptible. Radical cystectomy is a complex surgery that is often necessary in a population with extensive comorbidities. In this setting, the application of an unmodified system to deny reimbursement of adverse outcomes could have a significant effect on healthcare delivery. We hypothesized that measurable patient and hospital characteristics could predict the occurrence of NE complications after radical cystectomy. Using the weighted Nationwide Inpatient Sample database, we identified 61,142 patients with bladder cancer who underwent radical cystectomy from 2002 to 2009. The NE rates were calculated, and their effect on in-hospital mortality, length of stay, and total hospital costs were determined by multivariate regression analysis. Results: The rate for any NE was 2.42%. Vascular-catheter infections (1.25%) were the most common. Black race and comorbidities increased the likelihood of a NE. The presence of any NE increased the average length of stay (by 15 days), total costs (by $37,000), and in-hospital mortality (8.0% vs 2.2%). Conclusion: Centers for Medicare and Medicaid Services NEs are more likely in older patients with comorbidities. NEs strongly predict for negative patient outcomes during hospitalization (length of stay, costs, in-hospital mortality). High-risk populations could benefit from risk adjustment before implementing a significant alteration in hospital or physician reimbursement policies.