Surgical site infection: Incidence and impact on hospital utilization and treatment costs
United BioSource Corporation, 7101 Wisconsin Avenue, Bethesda, MD 20814, USA. American journal of infection control
(Impact Factor: 2.21).
05/2009; 37(5):387-97. DOI: 10.1016/j.ajic.2008.12.010
Surgical site infections (SSIs) are serious operative complications that occur in approximately 2% of surgical procedures and account for some 20% of health care-associated infections.
SSI was identified based on the presence of ICD-9-CM diagnosis code 998.59 in hospital discharge records for 7 categories of surgical procedures: neurological; cardiovascular; colorectal; skin, subcutaneous tissue, and breast; gastrointestinal; orthopedic; and obstetric and gynecologic. Source of data was the 2005 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS). Primary study outcomes were rate of SSI by surgical category and impact of SSI on length of stay and cost. Results were projected to the national level.
Among 723,490 surgical hospitalizations in the sample, 6891 cases of SSI were identified (1%). On average, SSI extended length of stay by 9.7 days while increasing cost by $20,842 per admission. From the national perspective, these cases of SSI were associated with an additional 406,730 hospital-days and hospital costs exceeding $900 million. An additional 91,613 readmissions for treatment of SSI accounted for a further 521,933 days of care at a cost of nearly $700 million.
SSI is associated with a significant economic burden in terms of extended length of stay and increased costs of treatment. Our analysis documented nearly 1 million additional inpatient-days and $1.6 billion in excess costs.
Available from: Julien Boetto
- "Surgical site infection (SSI) is the third most commonly reported health care associated infection in France . The occurrence of SSI increases hospitalization costs and length of stay, and impairs patients' quality of life   . Hence, reducing the rate of SSIs is an important medico-economic issue. "
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Spinal instrumentation has a high rate of surgical site infection (SSI), but results greatly vary depending on surveillance methodology, surgical procedures, or quality of follow-up. Our aim was to study true incidence of SSI in spinal surgery by significant data collection, and to compare it with the results obtained through the hospital information system.
This work is a single center prospective cohort study that included all patients consecutively operated on for spinal instrumentation by posterior approach over a six-month period regardless the etiology. For all patients, a "high definition" prospective method of surveillance was performed by the infection control (IC) department during at least 12months after surgery. Results were then compared with findings from automatic surveillance though the hospital information system (HIS).
One hundred and fifty-four patients were included. We found no hardly difference between "high definition" and automatic surveillance through the HIS, even if HIS tended to under-estimate the infection rate: rate of surgical site infection was 2.60% and gross SSI incidence rate via the hospital information system was 1.95%. Smoking and alcohol consumption were significantly related to a SSI.
Our SSI rates to reflect the true incidence of infectious complications in posterior instrumented adult spinal surgery in our hospital and these results were consistent with the lower levels of published infection rate. In-house surveillance by surgeons only is insufficiently sensitive. Further studies with more patients and a longer inclusion time are needed to conclude if SSI case detection through the HIS could be a relevant and effective alternative method.
Available from: Petteri Sjögren
- "Superficial incisional SSI is more common than deep organ/space SSI, and the cost and risks associated with SSI increase with the depth and extent of infection (Urban, 2006). De Lissovoy et al., (2009) examined cardiovascular, gynaecologic and orthopaedic surgery (with the exception of major joint surgery) with the aim to analyse the effect of SSI on length of hospital stay associated with SSI and cost. The greatest increase in length of hospital stay was observed for cardiovascular surgery, including 723,490 surgical procedures with an SSI rate at 1%, with a mean extension of 13.7 days. "
Available from: Julien Boetto
- "L'infection du site opératoire (ISO) représente la troisième cause d'infection rapportée aux soins . Sa survenue augmente les coûts et les durées d'hospitalisation, et impacte la qualité de vie des patients   . La lutte contre les ISO représente donc un important défi médico-économique. "
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