Direct economic burden of nosocomial infection in cardiovascular surgery patients based on DRG payment management

Abstract Objective To investigate the characteristics and direct economic burden of nosocomial infections in cardiovascular surgery patients using Diagnosis-Related Groups (DRG) stratification. Methods Clinical data of cardiovascular surgery patients were collected from January 2023 to December 2024. Propensity score matching or inverse probability of treatment weighting was employed for DRG subgroups to compare length of stay and hospitalization costs between nosocomial and non-nosocomial infection patients. Results The overall prevalence of nosocomial infection in cardiovascular surgery patients was 12.27%, with non-ventilator-associated lower respiratory tract infection (LRTI) predominating (90.57%). Infection rates varied substantially across DRG subgroups, and the rates in the heart valve surgery (FB29), complicated operation on great vessels (FE19) and coronary artery surgery (FC19) groups were 34.49%, 31.09% and 39.57%, respectively. Klebsiella pneumoniae was the most common pathogen in our study. Compared with uninfected patients, non-ventilator-associated LRTI significantly increased hospitalization costs in FB29 (cost ratio (CR) = 1.17, 95% confidence interval (CI): 1.01–1.36, P = 0.037), and consistently increased medicine costs in FB29 (CR = 1.50, 95% CI: 1.21–1.87), FE19 (CR = 1.27, 95% CI: 1.03–1.58), and FC19 (CR = 1.30, 95% CI: 1.01–1.66) (all P < 0.05). Conclusion DRG-stratified analysis revealed substantial heterogeneity in infection rates and additional hospital costs across cardiovascular surgery subgroups. The primary drivers of infection-attributable expenses differed across DRG groups. Further research on exploring clinically identifiable infection-related risk factors for specific DRGs is urgently needed to guide precise infection management and resource allocation.