Impact of Surgical Site Infections on Length of Stay and Costs in Selected Colorectal Procedures

Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Surgical Infections (Impact Factor: 1.45). 09/2009; 10(6):539-44. DOI: 10.1089/sur.2009.006
Source: PubMed


Length of stay (LOS) and inpatient costs for open-abdomen colorectal procedures have not been examined recently. The aim of this study was to determine LOS and costs for several colorectal procedures in the context of factors potentially associated with surgical site infection (SSI).
We used a large U.S. hospital database to identify the variables associated with longer LOS and higher costs for colorectal procedures from January 1, 2005, through June 30, 2006. The study population consisted of all patients >18 years, identified via International Classification of Disease, Ninth Revision, procedural codes for elective colorectal surgery. Patient demographics, surgical procedure, and a modified Study of the Efficacy of Nosocomial Infection Control (SENIC) infection risk score were examined using logistic regression as predictors of LOS >or=1 week and cost >or=$15,000. Patients given cefotetan as surgical prophylaxis were compared with patients given cefazolin/metronidazole. Superficial and deep SSIs were considered; intra-abdominal infection was not.
The 25,825 patients were of average age 63 years, with 53% being female and 75% being Caucasian. The overall infection rate was 3.7%. The mean LOS was 7.25 days, and the mean +/- standard deviation total cost per patient $13,746 +/- $13,330. Rates of infection, LOS, and mean hospital costs were all greater for patients with a high SENIC score and increasing disease acuity. Values for these outcome variables were highest for procedures involving stoma formation, followed by operations on the small bowel and large bowel. Variables independently predictive of longer LOS were SSI (odds ratio [OR] 11.74; 95% confidence interval [CI] 9.67, 14.26), age >or=65 years (OR 1.90; 95% CI 1.81, 2.01), and high SENIC score (OR 1.79; 95% CI 1.67, 1.92), whereas Caucasian race (OR 0.86; 95% CI 0.81, 0.91) was predictive of a shorter LOS. Cefazolin/metronidazole was not predictive of a shorter LOS compared with cefotetan (OR 1.06; 95% CI 0.96, 1.17) but was associated with significantly more hospitalizations with costs >or=$15,000 (OR 1.39; 95% CI 1.23, 1.56).
Length of stay and cost rise proportionally with SENIC score, disease acuity, and patient characteristics such as age. Surgical site infections are significantly and independently associated with LOS and cost and contribute to inpatient morbidity and expense. Cefotetan has limited availability, and substitutions are utilized increasingly. Although equally efficacious in elective colon procedures, cefotetan used as surgical prophylaxis was associated with lower hospitalization costs than cefazolin plus metronidazole.

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    • "SSI is one of the major causes of infections difficult to control and handle. It has been observed by many workers that the cost of treatment is increased due to over stay in the hospitals due to super and nosocomial infections (Sheng et al., 2007; Mahmoud et al., 2009; de Lissovoy et al., 2009; Broex et al., 2009). The resistance pattern of clinical isolates involved in SSIs may vary from one hospital to another hospital, surgeon to surgeon, procedure to procedure and from patient to patients (Nichols, 2001). "
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    ABSTRACT: Wound infections due to the incursion of microbes need to be averted or to heal the wounds by antibiotics. Antibiotics are not only aid in cure of infections but also help to prevent the flourishing and production of one or more species of microorganism, resultant in purulent discharge. This current study was carried out to evaluate the resistance pattern of clinical isolates from surgical site infections by the Kirby Bauer disc diffusion method. A total of 257 clinical isolates were collected from different hospitals in Karachi and evaluated by using fifteen antibiotics belonging to different groups. Staphylococcus aureus (n=87), Escherichia coli (n=76), Pseudomonas aeruginosa (n=56), Proteus (n=21) and Klebsiella (n=17) species are the most common clinical isolates of surgical site infections. Among the semi-synthetic penicillins, ampicillin was found to be resistant to nearly all clinical isolates but amoxicillin was moderately sensitive to S. aureus. Combinations of semi-synthetic penicillins are more sensitive than the penicillin alone. Co-amoxiclave exhibits superior sensitivity to all the surgical infection isolates except Pseudomonas aeruginosa which showed 68.75% resistance. Pseudomonas aeruginosa was highly resistant to cephalosporin except ceftraixone which showed 21.88% resistance. S. aureus was slightly responsive to cefazolin, cephradine, cefaclor, ceftizoxime, cefuroxime and ceftriaxone. E. coli, Gram-negative clinical isolate was showed 25% and 31.25% resistance to ceftriaxone and cefuroxime. In the Klebsiella species, 71.42% and 64.29% resistance to cefazolin and cefuroxime respectively, was observed. Aminoglycosides such as gentamycin and tobramycin were found to be more susceptible to all the clinical isolates. Quinolones like ofloxacin and enoxacin were showed good sensitivity to nearly all the clinical isolates.On the basis of the present study, it is recommended to adopt a rational use of antibiotics in prophylaxis and the utilization of a coordinated scheme of surgical wound inspections.
    Full-text · Article · Jan 2014 · Pakistan journal of pharmaceutical sciences
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    • "Further, this study utilises patient age as a control variable. The use of patient age as a control or moderating variable has been found in several studies of the present healthcare literature [22,23]. "
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    ABSTRACT: Physician collaboration, which evolves among physicians during the course of providing healthcare services to hospitalised patients, has been seen crucial to effective patient outcomes in healthcare organisations and hospitals. This study aims to explore physician collaborations using measures of social network analysis (SNA) and exponential random graph (ERG) model. Based on the underlying assumption that collaborations evolve among physicians when they visit a common hospitalised patient, this study first proposes an approach to map collaboration network among physicians from the details of their visits to patients. This paper terms this network as physician collaboration network (PCN). Second, SNA measures of degree centralisation, betweenness centralisation and density are used to examine the impact of SNA measures on hospitalisation cost and readmission rate. As a control variable, the impact of patient age on the relation between network measures (i.e. degree centralisation, betweenness centralisation and density) and hospital outcome variables (i.e. hospitalisation cost and readmission rate) are also explored. Finally, ERG models are developed to identify micro-level structural properties of (i) high-cost versus low-cost PCN; and (ii) high-readmission rate versus low-readmission rate PCN. An electronic health insurance claim dataset of a very large Australian health insurance organisation is utilised to construct and explore PCN in this study. It is revealed that the density of PCN is positively correlated with hospitalisation cost and readmission rate. In contrast, betweenness centralisation is found negatively correlated with hospitalisation cost and readmission rate. Degree centralisation shows a negative correlation with readmission rate, but does not show any correlation with hospitalisation cost. Patient age does not have any impact for the relation of SNA measures with hospitalisation cost and hospital readmission rate. The 2-star parameter of ERG model has significant impact on hospitalisation cost. Furthermore, it is found that alternative-k-star and alternative-k-two-path parameters of ERG model have impact on readmission rate. Collaboration structures among physicians affect hospitalisation cost and hospital readmission rate. The implications of the findings of this study in terms of their potentiality in developing guidelines to improve the performance of collaborative environments among healthcare professionals within healthcare organisations are discussed in this paper.
    Full-text · Article · Jun 2013 · BMC Health Services Research
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    • "The decision on recommendations for PA has to take many aspects into consideration, like tissue penetration, mechanism of antibacterial action, and half life in vivo. Other considerations of importance are impact on bacterial resistance in the hospital and the community, side effects , especially allergic reactions [12]. Nowadays, antibiotic prophylaxis administered 1 h before skin incision is a well established procedure for reducing SSI. "
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    ABSTRACT: Appropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of surgical site infection (SSI) after a clean contaminated cancer surgery. Our aim is to compare the use of two prophylactic antibiotic (PA) regimens as regards efficacy, timing, and cost. Two hundred patients with gastric, bladder, or colorectal cancer were randomized to receive preoperative PA, group A received penicillin G sodium and gentamicin and group B received clindamycin and amikacin intravenously. The demographic data of patients were collected, and they were observed for wound infections. Infected wounds occurred in 19 patients with a rate of 9.5%. Highest incidence of SSI was among bladder cancer patients (14.2%); p=0.044. The rate of SSI was 11% in group A, and 8% in group B, p=0.469. The cost of PA administered in group A was significantly less than that of group B (21.96±3.22LE versus 117.05±12.74LE, respectively; p<0.001). SSI tended to be higher among those who had longer time for antibiotic and incision (⩾30min) than those who had shorter time interval (<30min), (13% vs. 6.5%, respectively). Both penicillin+gentamicin and clindamycin+amikacin are safe and effective for the prevention of SSI in clean contaminated operative procedures. In a resource limited hospital, a regimen including penicillin+gentamicin is a cost-effective alternative for the more expensive and broader coverage of clindamycin+amikacin. Timing of PA is effective in preventing SSIs when administered 30min before the start of surgery.
    Full-text · Article · Mar 2013 · Journal of the Egyptian National Cancer Institute
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