Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-28T15:55:54.241Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Kathryn B. Kirkland ,
Jane P Briggs ,
Sharon L. Trivette ,
William E. Wilkinson  and
Daniel J. Sexton
Kathryn B. Kirkland*
Affiliation:
Department of Medicine, Durham, North Carolina
Jane P Briggs
Affiliation:
Durham Regional Hospital, Durham, North Carolina
Sharon L. Trivette
Affiliation:
Durham Regional Hospital, Durham, North Carolina
William E. Wilkinson
Affiliation:
Department of Medicine, Durham, North Carolina Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Department of Medicine, Durham, North Carolina Durham Regional Hospital, Durham, North Carolina
*
Box 3306, Duke University Medical Center, Durham, NC 27710
Get access Rights & Permissions [Opens in a new window]

Abstract

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 [CI95], 1.14.5). Seventy-four infected patients (29%) and 46 uninfected patients (18%) required ICU admission (RR, 1.6; CI95,1.3-2.0). 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 (CI95, 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 (CI95, $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; CI95, 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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 11 , November 1999 , pp. 725 - 730
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Graves, EJ. 1993 summary: National Hospital Discharge Survey. Adv Data 1995;264:1–12.Google Scholar
2. National Nosocomial Infections Surveillance System. Semiannual Report. Centers for Disease Control and Prevention: Atlanta, GA; December 1996.Google Scholar
3. Horan, TC, Culver, DH, Gaynes, RP, Jarvis, WR, Edwards, JR, Reid, CR, et al. Nosocomial infections in surgical patients in the United States, January 1986-June 1992. Infect Control Hosp Epidemiol 1993;14:73–80.CrossRefGoogle ScholarPubMed
4. Poulsen, KB, Wachmann, CH, Bremmelgaard, A, Sorensen, AI, Raahave, D, Petersen, JV. Survival of patients with surgical wound infection: a case-control study of common surgical interventions. Br J Surg 1995;82:208–209.CrossRefGoogle ScholarPubMed
5. Clarke, SKR. Sepsis in surgical wounds with particular reference to Staphylococcus aureus . Br J Surg 1957;44:592–596.CrossRefGoogle ScholarPubMed
6. Public Health Laboratory Service. Incidence of surgical wound infection in England and Wales. Lancet 1960;2:659–663.Google Scholar
7. Loewenthal, J. Sources and sequelae of surgical sepsis. BMJ 1962;1:1437–1440.CrossRefGoogle ScholarPubMed
8. Cruse, PJE, Foord, R. The epidemiology of wound infections: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27–40.CrossRefGoogle Scholar
9. Green, JW, Wenzel, RP. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg 1977;85:264–268.CrossRefGoogle Scholar
10. Freeman, J, Rosner, BA, McGowan, J Jr. Adverse effects of nosocomial infection. J Infect Dis 1979;140:732–740.CrossRefGoogle ScholarPubMed
11. Haley, RW, Schaberg, DR, Von Allmen, SD, McGowan, J Jr. Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis 1980;141:248–257.CrossRefGoogle ScholarPubMed
12. Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CD. definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.CrossRefGoogle Scholar
13. Emori, TG, Culver, DH, Horan, TC, Jarvis, WR, White, JW, Olson, DR, et al. National Nosocomial Infections Surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
14. Culver, DH, Horan, TC, Gaynes, RP, Martone, WJ, Marvis, WR, Emori, TG, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(suppl 3B):152S–157S.CrossRefGoogle ScholarPubMed
15. Rothman, KJ. Modern Epidemiology. Boston, MA: Little, Brown & Co; 1986:275–279.Google Scholar
16. Hollander, M, Wolfe, DA. Nonparametric Statistical Methods. New York, NY: John Wiley & Sons; 1973:33–38.Google Scholar
17. Candela, PV, Wenzel, RP. Postoperative wound infection after total abdominal hysterectomy: a controlled study of the increased duration of hospital stay and trends in postoperative wound infection. Am J Infect Control 1993;21:201–204.Google Scholar
18. Holtz, TH, Wenzel, R. Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control 1992;20:206–213.CrossRefGoogle ScholarPubMed
19. Sands, K, Vineyard, G, Platt, R. Surgical site infections occurring after hospital discharge. J Infect Dis 1996;173:963–970.CrossRefGoogle ScholarPubMed
20. Brown, RB, Bradley, S, Opitz, E, Cipriani, D, Pieczarka, R, Sands, M. Surgical wound infections documented after hospital discharge. Am J Infect Control 1987;15:54–58.CrossRefGoogle ScholarPubMed
21. Byrne, DJ, Lynch, W, Napier, A, Davey, P, Malek, M, Cuschieri, A. Wound infection rates: the importance of definition and post-discharge wound surveillance. J Hosp Infect 1994;26:37–43.CrossRefGoogle ScholarPubMed
22. Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991;91(suppl 3B):32S–38S.CrossRefGoogle ScholarPubMed
23. Davey, P, Hernanz, C, Lynch, W, Malek, M, Byrne, D. Human and non-financial costs of hospital-acquired infection. J Hosp Infect 1991;18(suppl A):79–84.CrossRefGoogle ScholarPubMed
24. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG, Munn, VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.CrossRefGoogle ScholarPubMed
25. Wenzel, RP. Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control: economic implications for hospitals under the prospective payment system. Am J Med 1985;78(suppl B):3–7.CrossRefGoogle Scholar
26. Haley, RW, White, JW, Culver, DH, Hughes, JM. The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system: an empirical determination from a nationally representative sample. JAMA 1987;257:1611–1614.CrossRefGoogle ScholarPubMed
27. Centers for Disease Control. Public health focus: surveillance, prevention, and control of nosocomial infections. MMWR 1992;41:783–787.Google Scholar