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The Cost of Surgical Site Infections

Summary and Comment |
May 28, 2014

The Cost of Surgical Site Infections

  1. Richard T. Ellison III, MD

The mean attributable cost of surgical site infections in the Veterans Affairs system in 2010 was $11,876.

  1. Richard T. Ellison III, MD

With today's emphasis on improving healthcare quality while decreasing cost, understanding the true costs of surgical site infections (SSIs) is important. Using data from the Veterans Affairs Surgical Quality Improvement Program and the Veterans Health Administration (VHA) Decision Support System, investigators performed a retrospective cohort analysis to assess SSI-associated costs among patients who underwent inpatient surgery at Veterans Affairs hospitals.

Between October 2009 and September 2010, 54,233 patients underwent surgery at any of the 129 hospitals involved; 1756 of them (3%) developed SSIs (superficial in 74%, deep in 26%). Risk factors for SSIs included emergency surgery, recent heavy alcohol use, diabetes, chronic obstructive pulmonary disease, and congestive heart failure. The risk-adjusted costs were 1.43 times higher for all patients with an SSI (1.25 and 1.93 times higher for patients with superficial and deep SSIs, respectively) than for patients without an SSI. The estimated increase in costs was $11,876 for SSIs overall ($7003 for superficial and $25,721 for deep infections). If the hospitals with SSI rates higher than the 50th percentile reduced their rates to those of institutions at the exact 50th percentile, the VHA could save an estimated $13,198,865 annually.

Comment

The authors acknowledge limitations of the study — for example, including only a 30-day postoperative follow-up period, which would limit the detection of SSIs in patients receiving implants (including joint prostheses), not including cardiac surgery patients, and using data from Veterans Affairs hospitals (where patients are generally sicker and more likely to be male than those in a private hospital). Still, these findings will be of great benefit in considering the cost-benefit of various approaches to SSI prevention.

  • Disclosures for Richard T. Ellison III, MD at time of publication Grant / research support NIH-NIAID

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