Assessment of risk and economic burden of surgical site infection (SSI) posthysterectomy using a U.S. longitudinal database

Edmiston, Charles E.; Bond-Smith, Giles; Spencer, Maureen; Chitnis, A.S.; Holy, Chantal E.; Chen, Brian Po-Han; Leaper, David

doi:10.1016/j.surg.2021.11.034

Cited by 4 publications

(1 citation statement)

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“…Although this may be possible, recent analyses of both colorectal infections and infections following abdominal hysterectomy would suggest that the probability is low. 24,37 Future prospective studies are warranted to supplement the results of the current analysis.…”

Section: Discussionmentioning

confidence: 94%

Risk and economic burden of surgical site infection following spinal fusion in adults

Edmiston

Leaper

Chitnis

et al. 2022

Infect. Control Hosp. Epidemiol.

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Background: Spinal fusion surgery (SFS) is one of the most common operations in the United States, >450,000 SFSs are performed annually, incurring annual costs >$10 billion. Objectives: We used a nationwide longitudinal database to accurately assess incidence and payments associated with management of postoperative infection following SFS. Methods: We conducted a retrospective, observational cohort analysis of 210,019 patients undergoing SFS from 2014 to 2018 using IBM MarketScan commercial and Medicaid–Medicare databases. We assessed rates of superficial/deep incisional SSIs, from 3 to 180 days after surgery using Cox proportional hazard regression models. To evaluate adjusted payments for patients with/without SSIs, adjusted for inflation to 2019 Consumer Price Index, we used generalized linear regression models with log-link and γ distribution. Results: Overall, 6.6% of patients experienced an SSI, 1.7% superficial SSIs and 4.9% deep-incisional SSIs, with a median of 44 days to presentation for superficial SSIs and 28 days for deep-incisional SSIs. Selective risk factors included surgical approach, admission type, payer, and higher comorbidity score. Postoperative incremental commercial payments for patients with superficial SSI were $20,800 at 6 months, $26,937 at 12 months, and $32,821 at 24 months; incremental payments for patients with deep-incisional SSI were $59,766 at 6 months, $74,875 at 12 months, and $93,741 at 24 months. Corresponding incremental Medicare payments for patients with superficial incisional at 6, 12, 24-months were $11,044, $17,967, and $24,096; while payments for patients with deep-infection were: $48,662, $53,757, and $73,803 at 6, 12, 24-months. Conclusions: We identified a 4.9% rate of deep infection following SFS, with substantial payer burden. The findings suggest that the implementation of robust evidence-based surgical-care bundles to mitigate postoperative SFS infection is warranted.

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Section: Discussionmentioning

confidence: 94%