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Excess Length of Stay, Extra Costs, and Attributable Mortality

David C. Classen, MD, MS; Stanley L. Pestotnik, MS, RPh; R. Scott Evans, PhD; James F. Lloyd; John P. Burke, MD

JAMA. 1997;277(4):301-306.

Abstract
Objective.
—To determine the excess length of stay, extra costs, and mortality attributable to adverse drug events (ADEs) in hospitalized patients.

Design.
—Matched case-control study.

Setting.
—The LDS Hospital, a tertiary care health care institution.

Patients.
—All patients admitted to LDS Hospital from January 1, 1990, to December 31,1993, were eligible. Cases were defined as patients with ADEs that occurred during hospitalization; controls were selected according to matching variables in a stepwise fashion.

Methods.
—Controls were matched to cases on primary discharge diagnosis related group (DRG), age, sex, acuity, and year of admission; varying numbers of controls were matched to each case. Matching was successful for 71% of the cases, leading to 1580 cases and 20197 controls.

Main Outcome Measures.
—Crude and attributable mortality, crude and attributable length of stay, and cost of hospitalization.

Results.
—ADEs complicated 2.43 per 100 admissions to the LDS Hospital during the study period. The crude mortality rates for the cases and matched controls were 3.5% and 1.05%, respectively (P<.001). The mean length of hospital stay significantly differed between the cases and matched controls (7.69 vs 4.46 days; P<.001) as did the mean cost of hospitalization ($10010 vs $5355; P<.001). The extra length of hospital stay attributable to an ADE was 1.74 days (P<.001). The excess cost of hospitalization attributable to an ADE was $2013 (P<.001). A linear regression analysis for length of stay and cost controlling for all matching variables revealed that the occurrence of an ADE was associated with increased length of stay of 1.91 days and an increased cost of $2262 (P<.001). In a similar logistic regression analysis for mortality, the increased risk of death among patients experiencing an ADE was 1.88 (95% confidence interval, 1.54-2.22; P<.001).

Conclusion.
—The attributable lengths of stay and costs of hospitalization for ADEs are substantial. An ADE is associated with a significantly prolonged length of stay, increased economic burden, and an almost 2-fold increased risk of death.

Author Affiliations
From the Department of Clinical Epidemiology, LDS Hospital, Salt Lake City, Utah.

Footnotes
Reprints: David C. Classen, MD, MS, Department of Clinical Epidemiology, LDS Hospital, Eighth Avenue and C Street, Salt Lake City, UT 84143.

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