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Surgical site infections related to significant excess costs
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Among surgical patients at Veterans Affairs hospitals, the cost of treating patients who developed surgical site infections was 1.43 times greater than the cost for those without infections, according to study results published in JAMA Surgery.
“The take-home message is that surgical site infections are not only painful to the patient, they are also costly to hospitals,” Marin Schweizer, PhD, of the Iowa City VA Health Care System and the University of Iowa, told Infectious Disease News. “It is important to know the amount that these infections cost so that business cases can be made for interventions to prevent them.”
Marin Schweizer
Schweizer and colleagues evaluated the excess costs associated with surgical site infections (SSIs), including deep and superficial SSIs, among 54,233 patients who underwent surgery at a VA hospital in fiscal year 2010. The mixed-effect models controlled for patient and surgical risk factors and for hospital-level variation in costs. The costs included the index hospitalization and 30-day readmissions.
Among the surgical patients, 1,756 (3.2%) developed an SSI: 0.8% developed a deep SSI and 2.4% developed a superficial SSI. The unadjusted cost for patients without SSIs was $31,580. For patients with an SSI, the unadjusted cost was $52,620. After adjustment, the cost for patients with an SSI was 1.43 times higher than those without an SSI (95% CI, 1.34-1.52). The difference was $11,876.
Patients with deep SSIs had an even higher cost: 1.93 times greater (95% CI, 1.71-2.18) than those without SSIs, with a difference of $25,721. Patients with superficial SSIs had a 1.25 times greater cost (95% CI, 1.17-1.35), with a difference of $7,003. The greatest cost, according to specialty, was among neurosurgery patients, followed by orthopedic surgery, general surgery, peripheral vascular surgery and urologic surgery.
The researchers evaluated potential cost savings if the SSI rates improved. They found that if the hospitals with the highest rates of infections (10th percentile) reduced their rates to those in the 50th percentile, the health system would save more than $6.7 million in 1 year.
“These data provide economic justification for implementing interventions to prevent surgical site infections,” Schweizer said. “These interventions could include patient-centered interventions such as testing patients for Staphylococcus aureus nasal colonization preoperatively and then decolonizing them using mupirocin and chlorhexidine gluconate. They could also include personnel interventions such as decreasing door openings in operating rooms to keep negative pressure air flow and decrease distractions.”
Schweizer said, in the future, she plans to evaluate the costs of interventions to prevent SSIs and determine the cost-effectiveness of those interventions. — by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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