Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden

Monahan, Mark; Jowett, Sue; Pinkney, Thomas; Brocklehurst, Peter; Morton, Dean; Abdali, Zainab; Roberts, Tracy

doi:10.1371/journal.pone.0232960

Cited by 98 publications

(89 citation statements)

References 71 publications

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“…Structural reasons linked to the country (and, therefore, to the healthcare system); but no differences were found regarding the status of the country by itself (high income vs. low/middle income) in accordance with the recent study of Monahan et al ( 28 ). However, it seems important to underline that few studies have been found for low-/middle-income countries and that they are as heterogeneous as those in Europe.…”

Section: Discussionsupporting

confidence: 87%

The Socioeconomic Impact of Surgical Site Infections

Piednoir¹,

Robert‐Yap

Baillet³

et al. 2021

Front. Public Health

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Précis: Surgical site infections are an ever-increasing phenomenon worldwide due to different factors. This brief report aimeds to highlight at a glance, for both physicians and political and institutional leaders, the economic burden of surgical site infections.Objectives: This brief report aimed to highlight the economic burden of surgical site infections (SSIs).Methods: A narrative review focusing on this subject has been carried out.Results: Surgical site infections are responsible for generating important costs. In 2017, a French cohort highlighted a mean cost of each SSI treatment to be around €1,814; the same year, the Centers for Disease Control and Prevention guidelines evaluated the mean cost caused by SSI treatment to be from $10,443 to $25,546 per SSI. This cost depends on many factors including the patient himself and the type of surgery.Conclusions: Prevention of the risk of infection is, therefore, a profitable concept for surgery that must be integrated within all healthcare managements worldwide.

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Section: Discussionsupporting

confidence: 87%

The Socioeconomic Impact of Surgical Site Infections

Piednoir¹,

Robert‐Yap

Baillet³

et al. 2021

Front. Public Health

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“…Surgical site infection (SSI), a leading healthcare-associated infection reported in low-and middle-income countries, remain a significant clinical challenge as it is associated with substantial mortality and morbidity [1,2]. SSI prolonged hospitalization, diminished quality of life, and imposed substantial cost burden [3,4]. SSI, including incisional SSI and organ/space SSI, is the most frequent postoperative complication of acute appendicitis, which is a common surgical emergency worldwide [5].…”

Section: Introductionmentioning

confidence: 99%

Thickness of subcutaneous fat is a risk factor for incisional surgical site infection in acute appendicitis surgery: a prospective study

2021

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Background Incisional surgical site infection (SSI) is a significant source of postoperative morbidity resulting in increased length of stay and cost. In this study, our aim was to evaluate the association between thickness of subcutaneous fat (TSF) and incisional SSI among patients undergoing open appendectomy in low-resource settings. Methods 90 patients with acute uncomplicated appendicitis who underwent emergency open appendectomy from December 2017 to August 2018 were included in this prospective study. TSF was measured preoperatively using ultrasound. TSF and other possible predictors of incisional SSI, including body mass index and other clinical characteristics, were assessed by univariate and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of TSF and the optimum cut-off value for TSF was determined using the Youden index. Results The prevalence of incisional SSI was 13.3% (12/90). TSF was independently associated with incisional SSI (P < 0.001). Additionally, history of smoking (P = 0.048) was also associated with incisional SSI. A model of incisional SSI using a cut-off of 23.0 mm for TSF was moderately accurate (area under curve 0.83, confidence interval 0.70–0.97; sensitivity 83.3%; specificity 76.9%). Conclusions The study demonstrated that TSF, as evaluated by ultrasound, is a predictor in the development of incisional SSI in patients with acute appendicitis undergoing open appendectomy. These findings suggest that ultrasound is useful both for the evaluation of TSF and the prediction of incisional SSI risk factor in low-resource settings.

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“…4 In addition, SSI was a significant predictor of patient morbidity and mortality, 5 associated with an extended duration of hospital stay, 6 and resulted in an increased healthcare cost. 7 Further, antimicrobial resistance in SSI was another challenge in the healthcare system. 8,9 In low-and middle-income countries, more than one in ten surgical patients developed SSI.…”

Section: Introductionmentioning

confidence: 99%

<p>Surgical Site Infections and Prophylaxis Antibiotic Use in the Surgical Ward of Public Hospital in Western Ethiopia: A Hospital-Based Retrospective Cross-Sectional Study</p>

Kefale¹,

Tegegne²,

Degu³

et al. 2020

IDR

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Objective: Surgical site infection (SSI) is one of the leading causes of hospital-acquired infection among hospitalized patients. It causes significant health problems and results in an extended length of hospital stay, increased cost, and increased patient morbidity and mortality. To prevent the development of SSI, surgical antibiotic prophylaxis (SAP) administration before surgery is an evidence-based practice. Therefore, this study aimed to assess the prevalence of SSIs and surgical antibiotic prophylaxis practice, and identifying the gap in practicing prophylactic surgical antibiotic use. Methods: A retrospective cross-sectional study design was conducted on randomly selected 281 participants who fulfilled the inclusion criteria. Appropriateness of surgical antibiotic prophylaxis was assessed by clinical pharmacists based on the standard treatment guideline. Descriptive and multivariate logistic regression analyses were performed in SPSS version 25. Statistical significance was set at p <0.05. Results: The overall prevalence of SSI was 19.6% (95% CI: 19-20.2). Majority of surgical patients (88.6%) got surgical antibiotic prophylaxis. Ceftriaxone and metronidazole (45.4%), and ceftriaxone (33.3%) were the most frequently used prophylactic antibiotics. Presence of comorbidity (AOR=9.18, 95% CI: 5.17-17.9, p<0.001), contaminated (AOR=6.01, 95% CI: 1.77-16.8, p=0.019) and dirty (AOR=7.20, 95% CI: 1.23-12.1, p=0.029) wound classes, devoid of prophylactic antibiotics (AOR=6.63, 95% CI: 0.89-19.3, p=0.006), the timing of prophylactic antibiotic administration between 1 hour and 2 hours before incision (AOR=8.2, 95% CI: 4.34-18.1, p=0.001), and 48 hours duration of surgical antimicrobial prophylaxis (AOR=7.20, 95% CI: 1.23-28.17, p=0.027) were significantly associated with the development of SSIs. Conclusion: The prevalence of SSI was relatively high despite most surgical patients were given prophylactic antibiotics. The presence of comorbidity, contaminated and dirty wound classes, devoid of prophylactic antibiotics, administering prophylactic antibiotics between 1 hour and 2 hours before incision, and 48 hours duration of surgical antibiotic prophylaxis were significantly associated with SSIs.

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Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden

Cited by 98 publications

References 71 publications

The Socioeconomic Impact of Surgical Site Infections

The Socioeconomic Impact of Surgical Site Infections

Thickness of subcutaneous fat is a risk factor for incisional surgical site infection in acute appendicitis surgery: a prospective study

<p>Surgical Site Infections and Prophylaxis Antibiotic Use in the Surgical Ward of Public Hospital in Western Ethiopia: A Hospital-Based Retrospective Cross-Sectional Study</p>

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