The Cost of Surgical Site Infections after Colorectal Surgery in the United States from 2001 to 2012: A Longitudinal Analysis

Abstract

Surgical site infections (SSIs) are among the most common types of postoperative complications in the United States and are associated with significant prevalence of morbidity and mortality in patients undergoing surgical interventions, especially in colorectal surgery (CRS) where SSI rates are significantly higher than those of similar operative sites. SSIs were identified from the National Inpatient Sample-Healthcare Cost and Utilization Project database from 2001 to 2012 based on the specification of an ICD-9 code. Propensity score matching was used to compare costs associated with SSI cases with those of non-SSI controls among elective and nonelective admissions. Results were projected nationally using Healthcare Cost and Utilization Project sampling methodology to evaluate the incidence of SSIs and ascertain the national cost burden retrospectively. Among 4,851,359 sample-weighted hospitalizations, 4.2 per cent (203,597) experienced SSI. Elective admissions associated with SSI-stayed hospitalized for an average of 7.8 days longer and cost $18,410 more than their counterparts who did not experience an SSI. Nonelective admissions that experienced an SSI had an 8.5-day longer hospital stay and cost $20,890 more than counterparts without perioperative infections. This represents a 3 per cent annual growth in costs for SSIs and seems to be largely driven by cost increases in treatment of SSIs for elective surgeries. Current efforts of SSI management after CRS focused on compliance with guidelines and tracking of infection rates would benefit from some improvements. Considering the growing costs and increase in resource utilization associated with SSIs from 2001 to 2012, further research on costs associated with management of SSIs specific to CRS is necessary.

Associations Between Social Risk Factors and Surgical Site Infections After Colectomy and Abdominal Hysterectomy

“…Surgical site infections (SSIs) are associated with significant morbidity, mortality, and costs after surgical procedures. 1,2 Complicating up to 5% of surgical procedures nationally, SSIs are common and often preventable. Consequently, reducing SSIs nationally is a priority for patient safety efforts led by The Joint Commission, the Centers for Medicare & Medicaid Services, and consumer organizations such as the Leapfrog Group.…”

Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

“…Three other studies 66–68 identified a negative impact of anastomotic leakage on long‐term cancer‐specific survival, particularly noting an increase in local recurrence. Current efforts at SSI management after colorectal surgery focus on compliance with guidelines and evaluation of infection rates, but Gantz and colleagues 69 recently suggested that improvement is needed. Martinez et al 70 .…”

The Impact of a Colorectal Care Bundle for Surgical Site Infections at an Academic Disproportionate Share Hospital With a Level I Trauma Center

“…3 Patients suffering from SSI after elective colorectal surgery, their hospital stay prolonged by 7.8 days and an increase in hospital cost by $18,410. 4 SSI after a nonelective colorectal surgery was associated with 8.5 days longer hospital stay and a cost increase of $20,890. 4 The treatment of SSI accounts for up to $10 billion in healthcare spending annually.…”

“…4 SSI after a nonelective colorectal surgery was associated with 8.5 days longer hospital stay and a cost increase of $20,890. 4 The treatment of SSI accounts for up to $10 billion in healthcare spending annually. 3 Consequently, there has been a focus on the reduction of SSI rates at the institutional and national health care policy levels.…”