Rate of hospital infections in cancer patients has increased but deaths have declined

A nationwide study on patient outcomes after cancer surgeries found that while infections during hospital stays increased during a 10-year period, the death rate from those infections declined. These findings suggest that diagnosis and management of health care-associated infection (HAI) have improved over time.

"Cancer patients often have surgery as part of their treatment and are at increased risk for developing health care-associated infection," said study lead author Jesse Sammon, DO, with the Vattikuti Urology Institute of Henry Ford Health System in Detroit, Michigan.

"Ironically, they have often been left out of previous studies of health care-associated infection following surgery precisely because they're at higher risk of developing these infections."

HAIs are one of the most common and dangerous adverse consequences of hospitalization—but they are preventable. Under pressure from growing public awareness, at least 27 states have enacted laws as of 2010, requiring health systems and hospitals to report HAI rates.

This increased public awareness was due in large part to the 1999 publication of the Institute of Medicine's landmark report, To Err is Human, which compelled the medical industry to examine the depth and breadth of the HAI problem. Medical facilities responded by adopting numerous guidelines and programs to better detect and prevent such infections. This study suggests that those initiatives are working.

Drawing on the Nationwide Inpatient Sample database, researchers identified more than 2.5 million patients who underwent major cancer surgery for one of eight types of malignancies between 1999 and 2009. The procedures included colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, pneumonectomy, pancreatectomy and prostatectomy.

Among the patients, Sammon and his colleagues found that the incidence of HAI related to these surgeries increased 2.7% per year during the 10-year study period; but at the same time, the rate of deaths linked to the HAIs declined 1.3% per year.

Although the results are encouraging, Sammon said they are tempered by additional findings that socio-demographic factors such as race and insurance status continue to be serious national health policy concerns.

When compared to white patients, African Americans showed a 26% increase in HAI. If a patient's health care payments were made through Medicare or Medicaid—or if the patient was uninsured—the odds of HAI went up 18% to 67%.

This study was published in Cancer (2013; doi:10.1002/cncr.28027).

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