Retrospective Analysis of Never Events In Panniculectomy and Abdominoplasty Patients and Their Financial Implications

Goals/Purpose: In October 2008, the Centers for Medicare and Medicaid Service (CMS) adapted a list from the National Quality Form (NQF) consisting of 10 hospital-acquired conditions (HAC). Currently, CMS doesn't provide reimbursements for treatments arising from these events. This study evaluated panniculectomy and abdominoplasty patients in a multi-surgeon Plastic Surgery practice to determine the incidence of HAC in this population.

Methods/Technique: A retrospective chart review identified 90 individuals undergoing abdominoplasty and panniculectomy from 2008 through 2010. The International Classification of Diseases (ICD) 9 codes corresponding to the CMS-adapted HAC of interest were then applied to identify patients that developed never events. The HAC examined are as follows: surgical site infections (SSI), vascular-catheter associated infections, deep venous thrombosis/pulmonary embolism, retained foreign body (RFB), catheter-related urinary tract infection,  poor glycemic control manifestations, falls and trauma, air embolism, pressure ulcers (stage III and IV), and blood incompatibility. Information regarding age, ASA, BMI and smoking were collected. Patients were divided into two groups: those that developed never events and those with no events.

Results/Complications:

Of the 90 patients, 15 (16.66%) developed never events; 14 patients (15.5%) developed SSI and 1 (1.11%) developed a RFB. No events occurred in the remaining 8 HAC categories. Risk factors included BMI, Cigarette Smoking and DM. 

Conclusion: SSI was the most common never event to occur. However, in light of the obvious prevalence of the risk factors BMI and DM in patients who develop these events, the question of whether or not never events are truly unavoidable arises. Despite this, awareness of the impact on patient care, health care and hospital reimbursement is vital to understanding the new paradigm of "one-size-fits-all" approach of CMS. The pendulum has swung to the left, it is important that we attain a much needed equilibrium through the invaluable discernment that comes from evidence based medicine.