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Cost of Hospital-Acquired Infection

a b c d
Mahmud Hassan , Howard P. Tuckman , Robert H. Patrick , David S. Kountz & Jennifer
e
L. Kohn
a
The Blanche and Irwin Lerner Center for Pharmaceutical Management Studies , Rutgers
University, New Brunswick in New Brunswick , New Jersey
b
Finance and economics in the School of Business , Fordham University in Bronx , New York
c
Finance and economics in the Rutgers Business School , Rutgers University, New Brunswick
in New Brunswick , New Jersey
d
Medical and Academic Affairs , Jersey Shore University Medical Center in Neptune , New
Jersey
e
Economics department , Drew University in Madison , New Jersey
Published online: 04 Sep 2010.

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 Hospital Topics, 88(3):82–89, 2010
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ISSN: 0018-5868 print

DOI: 10.1080/00185868.2010.507124

Cost of Hospital-Acquired Infection

MAHMUD HASSAN, HOWARD P. TUCKMAN, ROBERT H. PATRICK, DAVID S. KOUNTZ,
and JENNIFER L. KOHN

Abstract. The authors assessed the costs of hospital-acquired Several studies focus on the extent of the cost of
Downloaded by [Chulalongkorn University] at 19:40 27 December 2014

infections using rigorous econometric methods on publicly
available data, controlling for the interdependency of length
of stay and the incidence of hospital acquired infection, and
estimated the cost shares of different payers. They developed a
system of equations involving length of stay, incidence of in-
fection, and the total hospital care cost to be estimated using
simultaneous equations system. The main data came from the
State of New Jersey UB 92 for 2004, complimented with data
from the Annual Survey of Hospitals by the American Hospital
Association and the Medicare Cost Report of 2004. The au-
thors estimated that an incidence of hospital acquired infection
increases the hospital care cost of a patient by $10,375 and it
increases the length of stay by 3.30 days, and that a dispropor-
tionately higher portion of the cost is attributable to Medicare.
They conclude that reliable cost estimates of hospital-acquired
infections can be made using publicly available data. Their es-
timate shows a much larger aggregate cost of $16.6 billion as
opposed to $5 billion reported by the Centers for Disease Con-
trol and Prevention but much less than $29 billion as reported
elsewhere in the literature.
Keywords: nosocomial infection (NI), hospital-acquired in-
fection (HAI), infection cost
HAI suggesting that aggregate costs of infections in
the United States may vary from $5 billion to $29
billion (CDC 2000; Kohn, Corrigan, and Donald-
son 1999). These costs vary based on the nature of
the infection, ranging from $600 for a urinary tract
infection to $50,000 for prolonged bloodstream in-
fection (CDC 2000). Typically, such estimates are
derived from patient records and case studies, but
the Health Insurance Portability and Accountability
Act (HIPAA) of 1996 and other administrative con-
straints restrict the ability of researchers to conduct
studies.
A need exists for a methodology that can be used
to develop cost estimates using a public database,
one that provides data for a large enough number
of patients to accurately capture the costs given low
incidence of HAI in the population. In the present
study, we used a publicly available large dataset for
the empirical estimates of costs of HAI and estimate

T he incidence of hospital-acquired infection

(HAI), also known as nosocomial infection
(NI), is an important health problem for so-
ciety. For example, nearly, 5% of admitted patients
acquired infections in 2002 and nearly 6% of these
patients died (Centers for Disease Control and Pre-
vention [CDC] 2007). The problem is sufficiently
pervasive that many states presently mandate public
reporting of HAI rates. Moreover, Medicare has lim-
ited coverage of infections that occur due to hospital
error in an effort to reduce costs.
the shares of the costs for different payers. The sub-
sequent approach provides new insights into the
economic impact of HAI and contributes to the so-
cietal debate as to whether and how HAI should be
financed and treated.
BACKGROUND
The rate of HAI has increased over the past few
decades despite increasing attention to the prob-
lem and implementation of several infection con-
trol measures. Although fewer patients have been

Mahmud Hassan, PhD, is a professor of finance and economics, director of the Pharmaceutical Management MBA Program, and
the director of The Blanche and Irwin Lerner Center for Pharmaceutical Management Studies at Rutgers University, New
Brunswick in New Brunswick, New Jersey. Howard P. Tuckman, PhD, is a professor of finance and economics in the School of
Business at Fordham University in Bronx, New York. Robert H. Patrick, PhD, is an associate professor of finance and economics in
the Rutgers Business School at Rutgers University, New Brunswick in New Brunswick, New Jersey. David S. Kountz, MD, is Senior
Vice President of Medical and Academic Affairs at the Jersey Shore University Medical Center in Neptune, New Jersey. Jennifer L.
Kohn, PhD, is an assistant professor of economics in the economics department at Drew University in Madison, New Jersey.

82
 HOSPITAL TOPICS: Research and Perspectives on Healthcare
admitted to U.S. hospitals (36 million in 1995 vs. 38
million in 1975) and length of stay (LOS) has short-
ened (from 7.9 to 5.3 days) the number of NIs has
increased from 7.2 per 1000 patient days to 9.8, in
part because hospital inpatients are older and sicker
now than in the 1970s (Stone, Larson, and Kawar
2002). Seminal studies on the incidence and cost of
NI in the United States have been well documented
(Haley et al. 1985a, 1985b; Haley et al. 1987; Haley
1991). Despite the time lag since these studies were
conducted, the studies that were initially developed
as part of the Study on the Efficacy of Nosocomial
Infection Control are considered definitive. They
find a prevalence of 5.7 infections per 100 admis-
sions. A key feature is the extensive and systematic
Downloaded by [Chulalongkorn University] at 19:40 27 December 2014
review of each medical record to determine both
the incidence of infection and the incremental ser-
vices associated with infection including LOS and
the costs of additional tests and materials. Wenzel
(1985) estimated the aggregate annual cost of HAI
in the United States, using the SENIC data, to be
from $5 to $10 billion.
A consensus exists that the most significant incre-
mental cost associated with NI is additional LOS.
For example, Zhan and Miller (2003) studied ad-
ditional LOS, charges, and mortality attributable
to medical injuries during hospitalization. Using
Public Safety Indicators, they included an inci-
dence of infection measure developed by the Agency
for Healthcare Research and Quality to study dis-
charges from 994 hospitals in 28 states in 2000.
They found that infection is associated with 9.58
additional LOS, $38,656 in excess charges, and
4.31% mortality attributable to infection. It is
clear, however, that other variables also determine
cost.
Because of the myriad of different infections and
patient characteristics involved, researchers differ on
the best estimation technique to accurately capture
cost. One major branch of this literature uses vari-
ous case-matching methodologies following Haley
(1991) whereas the other uses regression method-
ologies such as those of Plowman et al. (2001) and
Graves et al. (2005). Recent articles have attempted
to create a better methodology to assess the effect
of NI. Schulgen et al. (2000) reviewed five differ-
ent methods including case matching and statisti-
cal regression methods and find that any method
that does not take into account underlying patient
heterogeneity and the time to infection is biased.
Graves et al. (2005) used instrumental variables to
address the endogeneity bias between LOS and the
83
likelihood of getting an infection. They concluded
that the existing literature may overstate the costs
of HAI because of endogeneity bias. Finally, Her-
waldt et al. (2006) conducted a prospective study
of surgical patients using a Cox proportional haz-
ard regression model to estimate attributable loss
associated with infection and found that NI is sig-
nificantly associated with higher costs and that the
relationship is not simple and affected substantially
by numerous patient characteristics.
METHOD
The literature on the cost of HAI discussed pre-
vious documents the interdependency of LOS and
incidence of infection (INFECT): once a patient
catches infection, LOS is likely to increase, along
with the cost of illness (Graves et al. 2005; Kilgore
et al. 2008). Likewise, the longer the patient stays,
the higher the probability of developing an infec-
tion. Cost of hospital care (COST) is a function of
LOS, incidence of infection, and several other con-
trols. This suggests the following system of equa-
tions as the empirical basis for this study:
LOS = α0 +α1 INFECT+αk Xk +u1 (1)
INFECT = β0 + β1 LOS + βn Xn + u2 (2)
COST = γ0 + γ1 LOS + γ2 INFECT
+ Ym Xm + u3 (3)
where Xk , Xn , and Xm are exogenous variables and
u1 , u2 , and u3 are error terms. LOS and COST are
continuous variables measured in days and dollars,
respectively. Following Bates et al. (1997) and Haley
(1991), cost measures are computed adjusting the
posted charges of the hospitals by cost to charge ra-
tios published in the Medicare hospital cost reports.
Incidence of infection (INFECT) is a binary vari-
able for a patient matching the patient’s ICD codes
(shown in Appendix A) with the relevant infection
ICD codes reported in the literature (Platt et al.
2002; Needleman et al. 2002; Rubin et al. 1999).
It is measured as 1 if a patient develops infection
while in hospital and 0 otherwise.
Several papers previously explored the accuracy
of billing data in identifying patients with HAI.
Ollendorf et al. (2002) compared retrospectively
the UB 92 administrative data for 122 patients
with clinically documented severe sepsis and were
able to identify 75.4% of those patients using the
 84
ICD-9 codes. Platt et al. (2002) analyzed infection
post coronary artery bypass surgery and found
58% accuracy of the HAI cases using claims data.
Stone et al. (2007) used about 10,000 patients
from 24 hospitals to compare the CDC protocol
for identification of central-line associated blood-
stream infection (CLA-BSI) with the ICD-9 based
measure, and found both the methods to be similar
in identifying the patients with the CLA-BSI.
Xm includes cost of care affecting factors, such
as presence of surgery, measure of case complexity,
a measure of teaching intensity, nursing intensity,
and other controls. It also includes payer-specific
binaries, such as Medicare, Medicare Managed care,
Medicaid, Medicaid Managed care, Blue Cross, and
Downloaded by [Chulalongkorn University] at 19:40 27 December 2014
HMO (commercial payee is the omitted reference
category) to control for unobserved variations in
plan-specific constraints of care. Following Graves
et al. (2005), the other control variables Xk and Xn
include age, gender, measure of case complexity, use
of procedure, and other controls.
We used a two-step procedure to estimate the pre-
vious system of equations. Note that binary repre-
sentation of incidence of infection does not measure
severity of infection that can directly affect LOS and
COST.
First, we decomposed observed LOS into two
parts: (1) PREDLOS preinfection number of days
until a patient develops infection and (2) INFLOS
postinfection LOS in the hospital following the on-
set of infection. We assumed higher severity of in-
fection leads to a higher value for INFLOS.
Using Equations 1 and 2, a reduced form LOS
equation was estimated using data from infection-
free patients (INFECT = 0), the estimated equation
shown in Appendix B. The estimated coefficients
are used to predict the infection-free component
of LOS (PREDLOS) for the INFECT = 1 group.
Postinfection components of the LOS (INFLOS)
of this group of patients are estimated residually
subtracting PREDLOS from their observed LOS.
Second, we estimated the cost (Equation 3) with
the entire data set substituting LOS and INFECT
by PREDLOS and INFLOS, respectively, for those
patients who developed infection (INFECT = 1),
and holding the LOS of the infection-free patients
(INFECT = 0) at their observed values.
Every patient is different in terms of clinical char-
acteristics, such as diagnosis, severity of illness, and
health status. We confirmed the presence of het-
eroscedasticity on both LOS and COST equations
using the White Test at 1% level of significance
Vol. 88, no. 3 2010
(Greene 1993). The estimation process must con-
trol for heterogeneity of patients to avoid biased es-
timates of the parameter standard errors, and hence
both equations are estimated by controlling for het-
eroscedasticity of the error terms.
The primary data source of our research is the
State of New Jersey’s Universal Billing (UB-92)
database, which includes all patients admitted into
hospitals in New Jersey in 2004. Because cost-
outlier patients are reimbursed at different rates by
some payers including Medicare, we excluded pa-
tients with LOS in excess of 90 days to minimize
administrative interventions in LOS management.
We also excluded newborns from our dataset. The
UB-92 data set contains most variables used in this
study but a few additional variables were added from
other sources including the intern to bed ratio (IN-
TERN) and the cost to charge ratio for each hos-
pital in New Jersey. These two variables were ob-
tained from the Medicare Cost report for 2004 and
the ratio of Medicaid Patient Days to Total Patient
Days (MEDICAID), and the share of nursing staff
in the total full time equivalent (FTE) number of
employees (NURSESHR) come from the American
Hospital Association’s (AHA) annual survey of hos-
pitals in 2004. The final count of the number of
patients used in the analysis is 1,547,702.
RESULTS
Descriptive statistics along with the definition of
the variables used in the study are shown in Table 1.
The overall rate of infection (INFECT) is estimated
to be 6.4% of all admitted patients, which is a bit
on the high side compared to the rate reported in
the literature (i.e., 5.7% [Haley et al. 1985a). Given
the higher concentration of larger teaching hospitals
in New Jersey, this difference is plausible as docu-
mented by Horan et al. (1986). Cost of hospital
(COST) care for the infected and noninfected pa-
tients is $29,790 and $10,042, respectively, with an
average cost of $11,305. LOS for HAI patients is
estimated to be 6.76 days longer than the infection-
free patients (a percentage increase of 290%, or
10.00 vs. 3.2 days.) A large majority of infected cases
are admitted on urgent (URGENT) basis, 86.6%
for infected and 47.8% for the noninfected cases.
Extent of comorbidity (CM) measured as the num-
ber of diagnoses recorded for the infected patients
group is 7.36 as compared to 3.8 for the noninfected
group. The share of patients with HAI is dispro-
portionately higher for Medicare (MCARE (62%))
compared to the proportion of overall Medicare
 HOSPITAL TOPICS: Research and Perspectives on Healthcare 85

TABLE 1. Definition of Variables and Mean Values

Variable Definition Infection No infection Combined

Infect 1 = Infection; 0 = no infection — — 0.0640

Medicare 1 = Medicare 0.6204 0.3076 0.3276
Medicaremc 1 = Medicare managed care 0.0148 0.0096 0.0099
Medicaid 1 = Medicaid 0.0408 0.0421 0.0420
Medicaidmc 1 = Medicaid managed care 0.0108 0.0222 0.0214
BC 1 = Blue Cross 0.0738 0.1451 0.1405
HMO 1 = non-Medicare HMO 0.1338 0.2996 0.2890
COM 1 = Commercial 0.0259 0.0548 0.0530
Cost ($) Cost-to-charge ratio × Charge 29,790 10,042 11,305
Charge ($) Unadjusted charge 79,513 26,780 30,152
LOS Length of hospital Stay 10.0097 3.2441 3.6768
Age Age in years 65.8932 47.7823 48.9407
Surgery 1 = Surgery performed 0.0914 0.1803 0.1746
1 = Admitted as urgent
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Urgent 0.8663 0.4780 0.5029

Ngt 1 = Nasogastric tube inserted 0.0720 0.0097 0.0138
ES 1 = Endotracheal suction performed 0.0614 0.0119 0.0150
OT 1 = Oxygen therapy performed 0.0035 0.0013 0.0015
Female 1 = woman; 0 = man 0.6103 0.5765 0.5787
CM Comorbidities = # of diagnoses 7.3617 3.8056 4.0331
Intern Internee to bed ratio 0.1264 0.1282 0.1281
Medicaid Ratio of Medicaid to total pat. days 0.1497 0.1555 0.1552
Nursehr Ratio of nurse hrs to total FTE hrs 0.2897 0.2891 0.2892
PREDLOS Predicted LOS 6.7088 3.2441 3.4651
INFLOS LOS attributable to infection 3.2965 0 0.2108
N Number of patients in the sample 98,989 1,448,624 1,547,702

patients (33%) in the study. The shares of infected ($3,144 × 3.30). This amount is consistent with
cases for Medicaid Managed Care (MCAREMC), the estimate by Kilgore et al. (2008).
Blue Cross (BC), HMO, and Commercial (COM) In 2004, 99,000 patients developed infection
payers are almost one half of the respective shares while in hospitals, suggesting that the aggregate cost
of patients in those payer groups. Blue Cross had
7.4% of the infected cases in contrast to the share of
14.1% of Blue Cross patients in the study. Several TABLE 2. Estimated Cost Equation
procedures performed are more frequent among the
patients with HAI than among infection-free group Variable Coefficient∗ SE
(e.g., Nasogastric Tube Insertion [NGT] is over 7
Constant −3, 396.4703 43.0926
times higher, 7.20% vs. 0.97%; Endotracheal Suc- PREDLOS 2, 527.9380 13.7028
tion [ES] is over 5 times higher, 6.14% vs. 1.19%). INFLOS 3, 143.8500 28.4694
The most important finding for the cost equation Medicare 229.3492 36.4899
Medicaremc 2, 152.1800 155.2405
in Table 2 is that an increase in INFLOS by 1 day Medicaid −2, 446.7730 65.4892
increases cost of hospital care by $3,144, whereas Medicaidmc −1, 480.9934 71.5476
an increase in infection-free LOS PREDLOS by BC 537.5529 32.2181
1 day increases hospital care cost by $2,528. The HMO 315.2989 27.4830
Female −1, 070.6358 21.5768
cost of an increase in INFLOS is above the cost Surgery 3, 178.3539 33.2139
of an increase in regular LOS PREDLOS by $616 CM 696.4988 9.7624
($3,144 vs. $2,528). This shows that cost of stay in Intern 9, 918.5433 98.9974
Medicaid 2, 657.3968 133.9897
hospital by one additional day once an infection is Nursehr 2, 496.0840 88.3558
acquired as opposed to regular stay increases by 24%
($616/$2,528). Given an average INFLOS of 3.30 Note. Adjusted R 2 = .615. All standard errors were
adjusted for heteroscedasticity.
days (Table 1), the incremental cost of hospital care ∗
p = 0.01.
services due to the incidence of infection is $10,375
 86
of infection was $1.03 billion ($10,375 × 99,000)
in New Jersey. Total cost of hospital care in New
Jersey in 2004 was $17.49 billion. Hence, 5.89%
(1.03/17.49) of hospital care cost is attributable to
HAI. Because 62.04% (see Table 1) of the patients
with infection are Medicare enrollees, the Medicare’s
share of the cost is $0.64 billion ($1.03 × 0.6204),
accordingly, $0.04 billion ($1.03 × 0.0408) for
Medicaid, $0.08 billion ($1.03 × 0.0738) for Blue
Cross, $0.14 billion ($1.03 × 0.1338) for HMOs,
and $0.03 billion ($1.03 × 0.0259) for Commer-
cial patients. Similarly, the shares of the costs for
Medicare Managed Care and the Medicaid Man-
aged Care are $0.016 billion and $0.011 billion,
respectively. The remaining 8% of the patients with
Downloaded by [Chulalongkorn University] at 19:40 27 December 2014
HAI include self-pay, indigents, and other payers.
Average cost of hospital care in Northeast region
of the United States is about 20% higher than the
national average in 2004 (Healthcare Cost and Uti-
lization Database 2004). As such, the costs of hos-
pital care for a national level extrapolation using
the data from New Jersey should be adjusted ac-
cordingly. Using this adjustment, we estimated the
cost of an episode of HAI in the United States to
be $8,300 ($10,375 × 0.80). Using the CDC esti-
mated number of patients having HAI in the United
States to be 2 million, we estimated the total cost of
infection in the country at $16.6 billion ($8,300 ×
2 million) in 2004 (CDC 2000). Even though this
amount is about three times as high as reported by
the CDC in 2000 ($5 billion), it is much less than
$17–29 billion as reported by Kohn et al. (1999).
DISCUSSION AND CONCLUSION
The combination of a very large database with
rigorous econometric estimation techniques leads to
several important findings that we expect may likely
trigger further research. First, our estimate of the
cost of additional LOS in hospitals for patients who
acquire infection during inpatient stay indicates that
the cost of the infected LOS is 24% above the cost of
infection-free days spent in a hospital. This suggests
that when a patient acquires HAI, it raises the cost
of his or her healthcare bill. The cost would be even
greater if we considered the opportunity cost of time
spent in the hospital as a result.
Second, the incremental cost of hospital care for
HAI is estimated to be $10,375. For a total 99,000
patients with infection in New Jersey, the total cost
of HAI is estimated to be $1.03 billion ($10,375 ×
99,000) in 2004. This is about 5.9% ($1.03 bil-
lion/$17.48 billion) of the total hospital care cost
Vol. 88, no. 3 2010
in New Jersey and it is clear that the State of New
Jersey could save substantial sums if the incidence
of HAI were reduced.
Third, the largest share of HAI cost is attributable
to Medicare (62%), followed by HMOs (13%), and
Blue Cross (7%). Given the proportions of patients
for Medicare, HMO, and Blue Cross as 33%, 29%,
and 14%, respectively of the total patients base,
Medicare accrues a disproportionately higher share
of the cost, suggesting that Medicare should be do-
ing more to examine ways to reduce HAI since it
stands to save substantial dollars as a result. It may
also be true that if the Obama administration is suc-
cessful in implementing a new universal healthcare
program, HAI is likely to raise the cost of hospital
stay for members of the new program. The public
programs appear to have the greatest stake in HAI
cost reduction.
Fourth, our estimate of $16.6 billion as the cost
of NI in the United States is much larger than the
estimates of $4.5 billion by Nguyen (2007) and $5
billion reported by the CDC (2007); they are less
than $17–29 billion reported by Kohn et al. (1999).
Finally, our model demonstrates that billing data
such as UB 92 can be used to estimate the cost of
HAI with reasonable accuracy. We hope that future
researchers use our analyses to refine and improve
the understanding of HAI and its causes and con-
sequences.
ACKNOWLEDGEMENTS
The authors thank the Department of Health and
Senior Services, State of New Jersey, for providing
us the UB 92 data for 2004. The authors also thank
the American Hospital Association for providing a
set of hospital specific data for the research. The
authors have no conflicts of interest or any financial
interest, relationship, and affiliation with the subject
matter or materials of this research.
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 88 Vol. 88, no. 3 2010

Appendix A. List of the ICD Codes Used to Appendix A. List of the ICD Codes Used to
Define the Infection Binary Define the Infection Binary

Source Code Description Source Code Description

1,2 38.0 Streptococcal Septicemia 2,3 711.00 Pyogen Arthritis-Unspec

2,3 38.1 Staph Septicemia 3 711.01 Pyogenic arthritis
2 38.10 Staph Septicemia Nos 3 711.02 Pyogenic arthritis
2 38.11 Staph Aureus Septicemia 3 711.03 Pyogenic arthritis
2 38.19 Staph Septicemia Nec 3 711.04 Pyogenic arthritis
2 38.2 Pneumococcal Septicemia 3 711.05 Pyogenic arthritis
2 38.3 Anerobic Septicemia 3 711.06 Pyogenic arthritis
2 38.4 Gram-neg Septicemia Nec 3 711.07 Pyogenic arthritis
2 38.4 Gram-neg Septicemia Nos 3 711.08 Pyogenic arthritis
3 421.0 Acute and subacute 3 711.09 Pyogenic arthritis
bacterial endocarditis 3 730.01 Acute osteomyelitis
1 482.0 Pneumonia 3 730.02 Acute osteomyelitis
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1 482.1 Pneumonia 3 730.03 Acute osteomyelitis

1 482.2 Pneumonia 3 730.04 Acute osteomyelitis
1,3 482.4 Pneumonia due to 3 730.05 Acute osteomyelitis
staphylococcus 3 730.06 Acute osteomyelitis
1 482.5 Pneumonia 3 730.07 Acute osteomyelitis
1 482.6 Pneumonia 3 730.08 Acute osteomyelitis
1 482.7 Pneumonia 3 730.09 Acute osteomyelitis
1 482.8 Pneumonia 3 730.10 Chronic osteomyelitis
1 482.9 Pneumonia 3 730.11 Chronic osteomyelitis
1 485.0 Pneumonia 3 730.12 Chronic osteomyelitis
1 486.0 Pneumonia 3 730.13 Chronic osteomyelitis
1 507.0 Pneumonia 3 730.14 Chronic osteomyelitis
1 514.0 Pneumonia 3 730.15 Chronic osteomyelitis
1 599.0 UT 3 730.16 Chronic osteomyelitis
2 611.0 Inflam Disease of Breast 3 730.17 Chronic osteomyelitis
2 674.3 Oth Comp OB Surg Wnd 3 730.18 Chronic osteomyelitis
2 682.0 Cellulitis of Face 3 730.19 Chronic osteomyelitis
2 682.1 Cellulitis of neck 2 780.6 fever
2 682.2 Cellulitis of Trunk 1 790.70 Sepsis
2 682.3 Cellulitis of Arm 2,3 790.7 Bacteremia
2 682.4 Cellulitis of Hand 2 875.00 Open Wnd-Chest/S Comp
2 682.5 Cellulitis of Buttock 2 875.10 Open Wnd Chest-Comp
2 682.6 Cellulitis of Leg 2 879.0 Open Wnd of Breast
2 682.7 Cellulitis of Foot 2 879.1 Open Wnd Breast-Comp
2 682.8 Cellulitis of Site Nec 2 879.2 Open Wnd Anterior Abdomen
2 682.9 Cellulitis Nos 2 879.3 Open Wnd Ant Abdomen-Comp
2 686.0 Pyoderma 2 879.4 Open Wnd Lateral Abdomen
2 686.1 Pyogenic Granuloma 2 879.5 Open Wnd Lateral
2 686.8 Local Skin Infection Nec Abdomen-Comp
2 686.9 Local Skin Infection Nos 2 879.6 Open Wnd Trunk Nec
2 879.7 Open Wnd Trunk Nec-Comp
2 879.8 Open Wnd Site Nos
2 879.9 Open Wnd Site Nos-comp
2 891.0 Open wnd low leg/s comp
2 891.1 Open wnd knee/leg- comp
1,2 958.3 Post-op would disruption
2 958.3 Posttram Wnd Infect Nec
2 996.6 Infect/Inflam-Dev/Graft
2 996.60 Infect D/T Device Nos
2 996.61 Infect D/T Hrt Device
2,3 996.62 Infect D/T Vasc Device
2 996.63 Infect D/T Nerv Device

(Appendix A continued on next page)

 HOSPITAL TOPICS: Research and Perspectives on Healthcare 89

(Appendix A continued)
Appendix B. Reduced Form LOS Equation:
Infection-Free Cases

Appendix A. List of the ICD Codes Used to Variable Estimation∗ SE ∗

Define the Infection Binary
Constant 1.4729 0.0179
Source Code Description Age −0.0739 0.0005
Age2 0.0006 0
1 996.6 UT Female −0.0241 0.0072
2 996.64 Infect D/T Urethral Cath Surgery −0.7007 0.0096
2 996.65 Infect D/T GU Device Nec CM 0.8419 0.0017
2,3 996.66 Infect D/T Joint Prosth NGT 5.6388 0.0369
2 996.67 Infect D/T Orth Device Nec ES 6.3164 0.0337
2 996.68 Infect D/T PD Cath OT 1.6115 0.0976
2 996.69 Infect D/T Device Nos Intern −0.0729 0.0267
2 998.0 Postoperative shock Medicaid 3.2694 0.0394
3 998.3 Disruption of operation wound Nursehr −0.5916 0.0434
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1,2,3 998.5 Postoperative infection

2 998.51 Infected Post-op Seroma Note. Adjusted R 2 = .2555. All standard errors were
2 998.59 Post-op Infection Nec adjusted for heteroscedasticity.
∗
2 998.83 Non-healing surg wnd p = 0.01.
2 998.90 Surgical comp NOS

Note.
Article Sources:
1. Needleman, B. et al., (2002)
2. Platt, K. et al., (2002)
3. Rubin, R. et al. (1999)
All codes from source articles cited to International Clas-
sification of Diseases, 9th Revision, Clinical Modifica-
tion.
All descriptions are most specific from source articles.