Chicago-based CommonSpirit Health, one of the largest healthcare systems in the country operating 138 hospitals in 21 states, has reported $451 million in operating losses for the six-month period ending Dec. 31.

Those figures compared with operating losses of $47 million for the same period in the prior year. Overall income for the second half of 2022 totaled a $213 million loss, but there was a gain of $200 million in the final quarter as stronger investment returns kicked in.

Staffing expenses continue to be a “major challenge,” CommonSpirit said. While salaries and benefits decreased $80 million in the final quarter, there was an overall increase of $140 million, or 1.7 percent, in such expenses over the second half of the year.

“We are meeting our challenges head on by scaling programs that drive growth, create a better experience for patients, and support our employees,” CFO Dan Morissette said in a statement. “At the same time we are working hard to reduce our costs so we can sustain these essential services in the long term.”

CommonSpirit estimated costs from its October cybersecurity event at approximately $150 million. The health system held $14.6 billion in debt as of Dec. 31.