Impact of Surgical Site Infections following common Ambulatory Procedures on Healthcare Costs

Surgical site infections (SSIs) not only increase morbidity and healthcare costs, they also impose emotional and physical burdens on patients and families. The SSI risk for patients undergoing a surgical procedure is specific to the type of surgery, degree of contamination of the operative field, and underlying patient risk factors (both modifiable and non-modifiable. This chapter reviews strategies to prevent surgical site infections in pediatric patients following general surgery, spine surgery for scoliosis, neurosurgical ventricular shunts, and cardiovascular surgery. Best practices and bundles used in leading pediatric healthcare facilities are described, including recommendations for perioperative antibiotic prophylaxis.

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The Bundle approach to reduce SSI rate of colon surgery, Piedmont (Italy): experience of 2012-2017

European Journal of Public Health ◽

10.1093/eurpub/ckz185.621 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Scacchi ◽

A D’Ambrosio ◽

E Rainero ◽

C Vicentini ◽

M F Furmenti ◽

...

Keyword(s):

Surgical Procedures ◽

Healthcare Costs ◽

Antimicrobial Prophylaxis ◽

Surgical Care ◽

Surgical Site Infections ◽

Colon Surgery ◽

Care Bundle ◽

Clinical Practices ◽

Prolonged Hospital ◽

Healthcare Associated

Abstract Background According to ECDC, Surgical Site Infections (SSI) are the second most frequent type of Healthcare Associated Infections (HAI) in Europe and in USA, and 9.5% of colon surgical procedures develop SSI. SSIs are associated with prolonged hospital stay, higher costs burden and higher attributable morbidity and mortality. Interventional programs can reduce the risk of SSI. Care bundles are a complex of EBM-based interventions on a specific population and setting, in order to improve clinical outcomes. A bundle is successful only if all its items are properly applied, through the ‘all-or-none’ method. Application of a bundle does not exclude other good clinical practices. Methods Data from 37 hospitals participating in the Regional SSI surveillance of Piedmont (Italy) were collected from 2012 to 2017. In hospitals applying the bundle, 4 bundle items had to be used in all the procedures: Temperature control, preoperative shower, trichotomy, antimicrobial prophylaxis. 6909 patients undergoing colon surgery were followed for 30 post-operative days to detect SSI events (According to ECDC 2016 Protocol). For some procedures, compliance to Bundle item application was ≤ 75%. Results 6909 procedures were assessed: 3631 with no bundle application and 3278 with bundle application; in particular 974 were compliant to all bundle items (100%), while 2304 were compliant to 3 items or less (≤ 75%). We report a SSI risk of 11.20% for surgical procedures performed without bundle application; this risk decreases to 5.63% (OR: 0.49, 95% CI: 0,36-0,67; p < 0.001) when compliance to bundle is 100%. When compliance to bundle is ≤ 75% instead of 100%, SSI risk raises to 8.47% (OR: 1.49, 95% CI: 1.07-2.04; p = 0.002). Conclusions Care bundle, if properly applied, is associated to statistically significant reduction of SSI rate (51%) for colon surgical procedures. Bundle programs should be encouraged and improved in hospitals to reduce healthcare costs and burden of HAIs. Key messages The use of the 4-item Surgical Care Bundle is associated to statistically significant reduction (51%) of SSI rate for colon surgical procedures. Surgical Care Bundle programs should be recommended and improved in every hospital to reduce healthcare costs and burden of HAIs.

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Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures

Annals of Surgery ◽

10.1097/sla.0000000000001590 ◽

2017 ◽

Vol 265 (2) ◽

pp. 331-339 ◽

Cited By ~ 14

Author(s):

Margaret A. Olsen ◽

Fang Tian ◽

Anna E. Wallace ◽

Katelin B. Nickel ◽

David K. Warren ◽

...

Keyword(s):

Health Care ◽

Quantile Regression ◽

Health Care Costs ◽

Surgical Site Infections ◽

The Impact ◽

Care Costs ◽

Ambulatory Procedures

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The cost of managing complex surgical site infections following primary hip and knee arthroplasty: A population-based cohort study in Alberta, Canada

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.199 ◽

2018 ◽

Vol 39 (10) ◽

pp. 1183-1188 ◽

Cited By ~ 6

Author(s):

Elissa D. Rennert-May ◽

John Conly ◽

Stephanie Smith ◽

Shannon Puloski ◽

Elizabeth Henderson ◽

...

Keyword(s):

Knee Arthroplasty ◽

Economic Burden ◽

Healthcare Costs ◽

Surgical Site Infections ◽

Population Based ◽

Infection Prevention And Control ◽

Clinical Databases ◽

Hip And Knee Arthroplasty ◽

The Cost ◽

And Control

AbstractObjectiveNearly 800,000 primary hip and knee arthroplasty procedures are performed annually in North America. Approximately 1% of these are complicated by a complex surgical site infection (SSI), leading to very high healthcare costs. However, population-based studies to properly estimate the economic burden are lacking. We aimed to address this knowledge gap.DesignEconomic burden study.MethodsUsing administrative health and clinical databases, we created a cohort of all patients in Alberta, Canada, who received a primary hip or knee arthroplasty between April 1, 2012, and March 31, 2015. All patients who developed a complex SSI postoperatively were identified through a provincial infection prevention and control database. A combination of corporate microcosting data and gross costing methods were used to determine total mean 12- and 24-month costs, enabling comparison of costs between the infected and noninfected patients.ResultsMean 12-month total costs were significantly greater in patients who developed a complex SSI compared to those who did not (CAD$95,321 [US$68,150] vs CAD$19,893 [US$14,223];P< .001). The magnitude of the cost difference persisted even after controlling for underlying patient factors. The most commonly identified causative pathogen (38%) wasStaphylococcus aureus(95% MSSA).ConclusionsComplex SSIs following hip and knee arthroplasty lead to high healthcare costs, which are expected to rise as the yearly number of surgeries increases. Using our costing estimates, the cost-effectiveness of different strategies to prevent SSIs should be investigated.

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