Impact of Surgical Site Infections on Length of Stay and Costs in Selected Colorectal Procedures
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.
[Show abstract] [Hide abstract] ABSTRACT: Postoperative infectious complications are independently associated with increased hospital length of stay (LOS) and cost and contribute to significant inpatient morbidity. Many strategies such as avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, metabolic control and early mobilization have been used to either prevent or reduce the incidence of postoperative infections. Despite these efforts, it remains a big challenge to our current healthcare system to mitigate the cost of postoperative morbidity. Furthermore, preoperative nutritional status has also been implicated as an independent risk factor for postoperative morbidity. Perioperative nutritional support using enteral and parenteral routes has been shown to decrease postoperative morbidity, especially in high-risk patients. Recently, the role of immunonutrition (IMN) in postoperative infectious complications has been studied extensively. These substrates have been found to positively modulate postsurgical immunosuppression and inflammatory responses. They have also been shown to be cost-effective by decreasing both tpostoperative infectious complications and hospital LOS. In this review, we discuss the postoperative positive outcomes associated with the use of perioperative IMN, their cost-effectiveness, current guidelines and future clinical implications.
- "Postoperative infectious complications are a major contributor to increased inpatient morbidity, hospital length of stay (LOS) and cost . Approximately 54% of all hospital-acquired infections occur in the postoperative phase . "
[Show abstract] [Hide abstract] ABSTRACT: Background: Incisional surgical site infection (SSI) is one of the most frequent complications that occur after colorectal surgery. Surgery for colorectal perforation carries an especially high risk of incisional SSI because fecal ascites contaminates the incision intraoperatively, and in patients who underwent stoma creation, the incision is located near the infective origin and is subject to infection postoperatively. Although effectiveness of the preventive SSI bundle of elective colorectal surgery has been reported, no study has focused exclusively on emergency surgery for colorectal perforation. Methods: Patients with colorectal perforation who underwent emergency surgery and stoma creation from 2010 to 2015 at our center were consecutively enrolled in the study. In March 2013, we developed the preventive incisional SSI bundle for patients with colorectal perforation undergoing stoma creation. The effectiveness of the bundle in these patients was determined and the rates of incisional SSI between before and after March 2013 were compared. Results: We enrolled 108 patients with colorectal perforation who underwent emergency operation during the study period. Thirteen patients were excluded because they died within 30 days after surgery, and 23 patients without stoma were excluded; thus, 72 patients were analyzed. There were 47 patients in the pre-implementation group and 25 patients in the post-implementation group. The rate of incisional SSI was significantly lower after implementation of preventive incisional SSI bundle (43 % vs. 20 %, p = 0.049). Postoperative hospital stay was significantly shorter after implementation of the bundle (27 vs. 18 days respectively; p = 0.008). Conclusions: The preventive incisional SSI bundle was effective in preventing incisional SSI in patients with colorectal perforation undergoing emergency surgery with stoma creation.
- "Moreover, SSI is significantly associated with longer hospital stay, which in turn results in higher inpatient costs6789. Mahmoud et al. retrospectively analyzed 25,825 patients and reported that SSI was significantly and independently associated with longer hospital stay and increased costs . Determining the strategies for its prevention could therefore improve patient care while lowering the duration and cost of hospital stay in patients at risk. "
[Show abstract] [Hide abstract] ABSTRACT: Surgical site infections (SSIs) are a major cause of morbidity, mortality, and hospital readmissions in general surgery patients. Real-time prediction of risk is needed prior to and during the time of an operation so that preventative strategies can be applied. In this study, we develop classifiers that can be used in real-time from combining operative data entered through a web interface and patient variables extracted from the EHR, to predict patients at risk for SSIs within 30 days of their operation, even before the patient leaves the operating room. We show that naïve Bayes (NB) and support vector machines (SVMs) can predict patients at risk for any SSI, or superficial SSIs, with high discriminatory power. We also show that applying the ChiMerge discretization method improves classifier performance to a greater extent in NB models than in SVMs. In addition, we identify the most important predictors by evaluating their normalized mutual information and chi squared statistic. Finally, we compare the SSI rates of discretized continuous variables and categorical variables, concluding that higher SSI rates are associated with lower preoperative hemoglobin, lower intraoperative temperature, larger estimated blood loss (EBL), longer procedure duration, larger transfusion volume, specific zip codes, dirtier wound class, specific surgeons, lower surgical apgar score (SAS), presence of an ostomy, higher American Society of Anesthesiology (ASA) score, higher total number of procedures during hospitalization, and open (vs laparoscopic) procedures.
- "Surgical site infections (SSIs) are a major cause of morbidity and hospital readmission, affecting 3-11% of general surgery patients in the United States [1,2]. They are associated with worse postoperative outcomes, including prolonged length of stay and higher mortality [3,4]. The additional healthcare costs attributed to SSIs are estimated to be over $20,000 per infection [5,6]. "