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The impact of surgical site infections on hospital contribution margin—a European prospective observational cohort study

Published online by Cambridge University Press:  17 October 2019

Marco von Strauss Open the ORCID record for Marco von Strauss [Opens in a new window] ,
Walter R. Marti ,
Edin Mujagic ,
Michael Coslovsky ,
Katharina Diernberger ,
Peter Hall ,
Jasmin Zeindler ,
Lilian A. Salm ,
Savas D. Soysal  and
Robert Mechera
...Show all authors
Marco von Strauss*
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Switzerland
Walter R. Marti
Affiliation:
Department of Surgery, Kantonsspital Aarau, Switzerland
Edin Mujagic
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland
Michael Coslovsky
Affiliation:
Clinical Trial Unit, University of Basel and University Hospital Basel, Switzerland
Katharina Diernberger
Affiliation:
Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland, United Kingdom
Peter Hall
Affiliation:
Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, Scotland, United Kingdom
Jasmin Zeindler
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland
Lilian A. Salm
Affiliation:
Department of Surgery, Kantonsspital Aarau, Switzerland
Savas D. Soysal
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Switzerland
Robert Mechera
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Switzerland
Urs von Holzen
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland Goshen Center for Cancer Care, Goshen, Indiana, United States
Walter P. Weber
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland
*
Author for correspondence: Marco von Strauss, Email: [email protected]
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Abstract

Background:

Surgical site infections (SSIs) are common surgical complications that lead to increased costs. Depending on payer type, however, they do not necessarily translate into deficits for every hospital.

Objective:

We investigated how surgical site infections (SSIs) influence the contribution margin in 2 reimbursement systems based on diagnosis-related groups (DRGs).

Methods:

This preplanned observational health cost analysis was nested within a Swiss multicenter randomized controlled trial on the timing of preoperative antibiotic prophylaxis in general surgery between February 2013 and August 2015. A simulation of cost and income in the National Health Service (NHS) England reimbursement system was conducted.

Results:

Of 5,175 patients initially enrolled, 4,556 had complete cost and income data as well as SSI status available for analysis. SSI occurred in 228 of 4,556 of patients (5%). Patients with SSIs were older, more often male, had higher BMIs, compulsory insurance, longer operations, and more frequent ICU admissions. SSIs led to higher hospital cost and income. The median contribution margin was negative in cases of SSI. In SSI cases, median contribution margin was Swiss francs (CHF) −2045 (IQR, −12,800 to 4,848) versus CHF 895 (IQR, −2,190 to 4,158) in non-SSI cases. Higher ASA class and private insurance were associated with higher contribution margins in SSI cases, and ICU admission led to greater deficits. Private insurance had a strong increasing effect on contribution margin at the 10th, 50th (median), and 90th percentiles of its distribution, leading to overall positive contribution margins for SSIs in Switzerland. The NHS England simulation with 3,893 patients revealed similar but less pronounced effects of SSI on contribution margin.

Conclusions:

Depending on payer type, reimbursement systems with DRGs offer only minor financial incentives to the prevention of SSI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 12 , December 2019 , pp. 1374 - 1379
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

Authors of equal contribution.

References

Badia, JM, Casey, AL, Petrosillo, N, Hudson, PM, Mitchell, SA, Crosby, C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 2017;96:1–15.CrossRefGoogle ScholarPubMed
Coello, R, Charlett, A, Wilson, J, Ward, V, Pearson, A, Borriello, P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect 2005;60:93–103.CrossRefGoogle ScholarPubMed
Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.CrossRefGoogle ScholarPubMed
Rosenthal, MB. Nonpayment for performance? Medicare’s new reimbursement rule. N Engl J Med 2007;357:1573–1575.CrossRefGoogle ScholarPubMed
Eappen, S, Lane, BH, Rosenberg, B, et al. Relationship between occurrence of surgical complications and hospital finances. JAMA 2013;309:1599–1606.CrossRefGoogle ScholarPubMed
Barie, PS. No pay for no performance. Surg Infect 2007;8:421–433.CrossRefGoogle ScholarPubMed
Figueroa, JF, Wang, DE, Jha, AK. Characteristics of hospitals receiving the largest penalties by US pay-for-performance programmes. BMJ Qual Saf 2016;25:898–900.CrossRefGoogle ScholarPubMed
Lewis, SS, Moehring, RW, Chen, LF, Sexton, DJ, Anderson, DJ. Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 2013;34:1229–1230.CrossRefGoogle Scholar
Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278; quiz 279–280.CrossRefGoogle ScholarPubMed
Vegas, AA, Jodra, VM, Garcia, ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 1993;9:504–510.Google Scholar
Poulsen, KB, Bremmelgaard, A, Sorensen, AI, Raahave, D, Petersen, JV. Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs. Epidemiol Infect 1994;113:283–295.CrossRefGoogle ScholarPubMed
Weber, WP, Zwahlen, M, Reck, S, et al. Economic burden of surgical site infections at a European university hospital. Infect Control Hosp Epidemiol 2008;29:623–629.CrossRefGoogle Scholar
Broex, EC, van Asselt, AD, Bruggeman, CA, van Tiel, FH. Surgical site infections: how high are the costs? J Hosp Infect 2009;72:193–201.CrossRefGoogle ScholarPubMed
Dimick, JB, Pronovost, PJ, Cowan, JA, Lipsett, PA. Complications and costs after high-risk surgery: where should we focus quality improvement initiatives? J Am Coll Surg 2003;196:671–678.CrossRefGoogle ScholarPubMed
Weber, WP, Mujagic, E, Zwahlen, M, et al. Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial. Lancet Infect Dis 2017;17:605–614.CrossRefGoogle ScholarPubMed
Mujagic, E, Zwimpfer, T, Marti, WR, et al. Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial. Trials 2014;15:188.CrossRefGoogle ScholarPubMed
DVS ESH. Jahresmittelkurse 2015. https://www.estv.admin.ch/estv/de/home/direkte-bundessteuer/wehrpflichtersatzabgabe/dienstleistungen/jahresmittelkurse.html. Published 2018. Accessed February 1, 2019.Google Scholar
Eurostat. Purchasing power parities in the European Union. https://ec.europa.eu/eurostat/web/purchasing-power-parities/data/main-tables. Published 2015. Accessed October 26, 2018.Google Scholar
Team, RC. A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; 2018.Google Scholar
Koenker, R. quantreg: Quantile Regression. R package version 5.35. Vienna: R Foundation for Statistical Computing; 2018.Google Scholar
Haider, AH, Gupta, S, Zogg, CK, et al. Beyond incidence: costs of complications in trauma and what it means for those who pay. Surgery 2015;158:96–103.CrossRefGoogle ScholarPubMed
Leaper, DJ, van Goor, H, Reilly, J, et al. Surgical site infection—a European perspective of incidence and economic burden. Int Wound J 2004;1:247–273.CrossRefGoogle ScholarPubMed
Wick, EC, Hirose, K, Shore, AD, et al. Surgical site infections and cost in obese patients undergoing colorectal surgery. Arch Surg 2011;146:1068–1072.CrossRefGoogle Scholar
Alfonso, JL, Pereperez, SB, Canoves, JM, Martinez, MM, Martinez, IM, Martin-Moreno, JM. Are we really seeing the total costs of surgical site infections? A Spanish study. Wound Repair Regen 2007;15:474–481.CrossRefGoogle ScholarPubMed
Eappen, S, Rosenberg, B, Gawande, AA. Complications from surgery and hospital finances—reply. JAMA 2013;310:747–748.CrossRefGoogle Scholar
Jenks, PJ, Laurent, M, McQuarry, S, Watkins, R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect 2014;86:24–33.CrossRefGoogle ScholarPubMed
Scally, CP, Thumma, JR, Birkmeyer, JD, Dimick, JB. Impact of surgical quality improvement on payments in medicare patients. Ann Surg 2015;262:249–252.CrossRefGoogle ScholarPubMed
Papanicolas, I, McGuire, A. Do financial incentives trump clinical guidance? Hip Replacement in England and Scotland. J Health Econ 2015;44:25–36.CrossRefGoogle ScholarPubMed
von Strauss Und Torney, M, Thommen, S, Dell-Kuster, S, et al. Surgical treatment of uncomplicated diverticulitis in Switzerland: comparison of population-based data over two time periods. Colorect Dis 2017;19:840–850.CrossRefGoogle ScholarPubMed
Mehra, T, Koljonen, V, Seifert, B, et al. Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model. Swiss Med Wkly 2015;145:w14217.Google ScholarPubMed
Boyce, JM, Potter-Bynoe, G, Dziobek, L. Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol 1990;11:89–93.CrossRefGoogle ScholarPubMed
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