Sources and Sequelae of Surgical Sepsis

Loewenthal, John

doi:10.1136/bmj.1.5290.1437

Cited by 18 publications

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“…Comparison methods. After completing the physician's assessment of costs, we attempted to estimate the extra days and resulting routine charges independently by two comparison approaches-first, with use of matching techniques similar to those reported in several previous match-ing studies [5,6,8,[11][12][13][14][15] and second, with no matching, as in studies performed by other researchers [3,7,9,10].…”

Section: Methodsmentioning

confidence: 99%

“…An important prereqursite for performing valid cost-benefit analysis of infection surveillance and control programs in hospitals is to obtain an accurate measure of the extra costs incurred by patients who acquire nosocomial infections. Since 1934, a number of investigators has attempted to estimate these costs [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Most have confined themselves to measuring the portion of direct costs represented by prolongation of hospitalization and the resulting charges that would not have been incurred in the absence of nosocomial infection.…”

mentioning

confidence: 99%

“…Most have confined themselves to measuring the portion of direct costs represented by prolongation of hospitalization and the resulting charges that would not have been incurred in the absence of nosocomial infection. They have generally estimated prolongation by concurrently observing patients [1][2][3][4] or by retrospectively comparing the total length of stay of infected patients with that of uninfected patients 1 [3,[5][6][7][8][9][10][11][12][13][14][15], sometimes matched by various characteristics [5,6,8,[11][12][13][14][15]. Since the estimates reported from these studies have varied widely, we compared the physician's estimate method with the comparison one by using both to study the same patient population.…”

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confidence: 99%

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Estimating the Extra Charges and Prolongation of Hospitalization Due to Nosocomial Infections: A Comparison of Methods

Haley

Schaberg

Allmen

et al. 1980

Journal of Infectious Diseases

160

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Estimates of the economic consequences of nosocomial infections were derived by studying the same patient population with two different methods: physician's assessment and comparisons of patients with nosocomial infection and those without, matched on five characteristics. Estimates of extra days and extra routine charges obtained by the comparison were about 2 1/2 times greater than those obtained by the physician's assessment (P less than 0.0001). Even when the match of patients was exact and measures were taken to avoid confounding, patients with nosocomial infection had more discharge diagnoses recorded (P = 0.02) and experienced more episodes of pulmonary embolism, renal failure, and death in the hospital than did their counterparts. These differences suggest that, despite careful matching, the members of the pairs were not comparable in their intrinsic predisposition to prolonged hospitalization. Unless patients can be matched on this prediposition, the estimates from a comparison study will be exaggerated.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Estimating the Extra Charges and Prolongation of Hospitalization Due to Nosocomial Infections: A Comparison of Methods

Haley

Schaberg

Allmen

et al. 1980

Journal of Infectious Diseases

160

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“…[5][6][7][8][9][10][11] Estimates of the excess length of stay attributable to SSI in studies conducted in the 1950s through the early 1980s ranged from 7 to 24 days. [5][6][7][8][9][10][11] The advent of the DRG system in the United States in the early 1980s increased pressure on hospitals to shorten patients' hospital stays. In the one prior study that estimated the excess length of stay attributable to SSI in the "DRG era," the mean excess length of stay associated with SSI following total abdominal hysterectomy in the late 1980s was 3.6 days, 17 approximately one half of what it had been in the mid-1970s.…”

Section: Discussionmentioning

confidence: 99%

“…However, published estimates of the actual excess days and costs attributable to SSI reflect hospitalization patterns prior to the current era of diagnosis-related groups (DRGs) and managed care. [5][6][7][8][9][10][11] We conducted a study of SSI in a community hospital in order to examine the mortality, the need for intensive care unit (ICU) admission, the need for readmission to the hospital within 30 days of discharge, the excess length of stay, and the extra costs attributable to SSI in the DRG and managed-care era. …”

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confidence: 99%

The Impact of Surgical-Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, And Extra Costs

Kirkland

Briggs

Trivette

et al. 1999

Infect. Control Hosp. Epidemiol.

1,511

823

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OBJECTIVE:To determine mortality, morbidity, and costs attributable to surgical-site infections (SSIs) in the 1990s.DESIGN: A matched follow-up study of a cohort of patients with SSI, matched one-to-one with patients without SSI.SETTING: A 415-bed community hospital. STUDY POPULATION: 255 pairs of patients with and without SSI were matched on age, procedure, National Nosocomial Infection Surveillance System risk index, date of surgery, and surgeon. OUTCOME MEASURES: Mortality, excess length of hospitalization, and extra direct costs attributable to SSI; relative risk for intensive care unit (ICU) admission and for readmission to the hospital.RESULTS: Of the 255 pairs, 20 infected patients (7.8%) and 9 uninfected patients (3.5%) died during the postoperative hospitalization (relative risk [RR], 2.2; 95% confidence interval [CI 95 ], 1.1-4.5). Seventy-four infected patients (29%) and 46 uninfected patients (18%) required ICU admission (RR, 1.6; CI 95 , 1.3-2.0). The median length of hospitalization was 11 days for infected patients and 6 days for uninfected patients. The extra hospital stay attributable to SSI was 6.5 days (CI 95 , 5-8 days). The median direct costs of hospitalization were $7,531 for infected patients and $3,844 for uninfected patients. The excess direct costs attributable to SSI were $3,089 (CI 95 , $2,139-$4,163). Among the 229 pairs who survived the initial hospitalization, 94 infected patients (41%) and 17 uninfected patients (7%) required readmission to the hospital within 30 days of discharge (RR, 5.5; CI 95 , 4.0-7.7). When the second hospitalization was included, the total excess hospitalization and direct costs attributable to SSI were 12 days and $5,038, respectively.CONCLUSIONS: In the 1990s, patients who develop SSI have longer and costlier hospitalizations than patients who do not develop such infections. They are twice as likely to die, 60% more likely to spend time in an ICU, and more than five times more likely to be readmitted to the hospital. Programs that reduce the incidence of SSI can substantially decrease morbidity and mortality and reduce the economic burden for patients and hospitals (Infect Control Hosp Epidemiol 1999;20:725-730).Each year, more than 18 million surgical procedures are performed in US hospitals. 1 The Centers for Disease Control and Prevention (CDC) estimates that 2.7% of these are complicated by surgical-site infections (SSIs), accounting for at least 486,000 nosocomial infections each year. 2 Such infections often lead to substantial morbidity and probably contribute to mortality in some patients. 3,4 However, the extent of morbidity and mortality attributable to SSI is not known. It is generally accepted that SSIs, like other nosocomial infections, prolong hospital stays and add to the economic costs of hospitalization. However, published estimates of the actual excess days and costs attributable to SSI reflect hospitalization patterns prior to the current era of diagnosis-related groups (DRGs) and managed care. [5][6][7][8][9][10][11] We conducted a ...

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Phlebography of the lower limb

Halliday

1968

Journal of British Surgery

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Sources and Sequelae of Surgical Sepsis

Cited by 18 publications

References 0 publications

Estimating the Extra Charges and Prolongation of Hospitalization Due to Nosocomial Infections: A Comparison of Methods

Estimating the Extra Charges and Prolongation of Hospitalization Due to Nosocomial Infections: A Comparison of Methods

The Impact of Surgical-Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, And Extra Costs

Phlebography of the lower limb

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