Direct healthcare costs associated with reported patient safety incidents in two tertiary hospitals in Colombia

BACKGROUND: Patient safety incidents are a leading cause of morbidity and mortality, and impose a substantial financial burden on health systems. This study aimed to determine the direct healthcare costs associated with reported patient safety incidents in two tertiary hospitals in Colombia between 2020 and 2022. METHODS: A retrospective cohort study was conducted using hospital discharge records classified by diagnosis-related groups and linked to patient safety incidents reports. The outcome was the direct cost per hospital episode, adjusted for inflation and expressed in United States dollars as of October 2022. Descriptive, bivariate, and multivariate analyses were performed using a log-linear model with gamma distribution to estimate adjusted cost ratios. RESULTS: Among 68.521 hospital episodes, 9.002 (13.1%) included at least one patient safety incident report. Episodes with reported patient safety incidents accounted for 31.2% of total costs and had a median cost 2.3 times higher than episodes without reports ($2.799 vs. $1.194; p < 0.001). Most reported incidents (90%) caused negligible or mild harm but accounted for 86.7% of total patient safety–related costs. After adjustment, hospital episodes with patient safety incidents remained associated with higher costs (CR: 1.15; 95% CI: 1.12 to 1.18; p < 0.001). Longer hospital lenght of stay, admission to intensive care units, and invasive mechanical ventilation were the main cost drivers. CONCLUSIONS: Patient safety incidents significantly increase hospitalization costs, even when harm is minimal. The findings highlight the cumulative financial impact of mild safety events and reinforce the need for systematic reporting and prevention strategies. Investments in patient safety represent not only an ethical imperative but also a potential cost-effective approach to improving health system sustainability.