This study examined interhospital variation in 180-day postoperative infection rates (including UTI, pneumonia, sepsis, sternal wound infection, and others) among 239,039 Medicare beneficiaries undergoing cardiac surgery at 1,007 hospitals between January 2018 and June 2023, and linked those rates to Medicare spending and clinical outcomes.
Infections occurred in 20.8% of procedures. High- vs. low-tercile infection-rate hospitals were associated with +$15,757 in mean 180-day Medicare spending per procedure (95% CI: $15,169–$16,345); infection rates explained 23.6% of spending variation. Benchmarking to the lowest tercile could prevent ~2,603 infections and ~$441M in annual Medicare payments.
Observational Medicare claims data cannot establish causation; coding accuracy for infection diagnoses may vary by hospital. The cohort is limited to Medicare beneficiaries (mean age 74.2 years, predominantly White), limiting generalizability to younger or commercially insured populations.
Hospitals in the highest infection-rate tercile carry a substantial cost and outcomes burden after cardiac surgery — reducing postoperative infections toward best-practice benchmarks could meaningfully cut both patient harm and healthcare spending. Cardiac surgery programs should benchmark their 180-day infection rates against low-tercile peers as a quality and cost-reduction target.
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