Major article
Surgical site infection: Incidence and impact on hospital utilization and treatment costs

https://doi.org/10.1016/j.ajic.2008.12.010Get rights and content

Background

Surgical site infections (SSIs) are serious operative complications that occur in approximately 2% of surgical procedures and account for some 20% of health care-associated infections.

Methods

SSI was identified based on the presence of ICD-9-CM diagnosis code 998.59 in hospital discharge records for 7 categories of surgical procedures: neurological; cardiovascular; colorectal; skin, subcutaneous tissue, and breast; gastrointestinal; orthopedic; and obstetric and gynecologic. Source of data was the 2005 Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS). Primary study outcomes were rate of SSI by surgical category and impact of SSI on length of stay and cost. Results were projected to the national level.

Results

Among 723,490 surgical hospitalizations in the sample, 6891 cases of SSI were identified (1%). On average, SSI extended length of stay by 9.7 days while increasing cost by $20,842 per admission. From the national perspective, these cases of SSI were associated with an additional 406,730 hospital-days and hospital costs exceeding $900 million. An additional 91,613 readmissions for treatment of SSI accounted for a further 521,933 days of care at a cost of nearly $700 million.

Conclusion

SSI is associated with a significant economic burden in terms of extended length of stay and increased costs of treatment. Our analysis documented nearly 1 million additional inpatient-days and $1.6 billion in excess costs.

Section snippets

Study data

The study is based on 2005 hospital stay data from the Nationwide Inpatient Sample (NIS), a component of the Agency for Healthcare Quality and Research (AHRQ) Healthcare Cost and Utilization Project (HCUP).3 HCUP is a federally sponsored nationally representative survey designed to approximate a 20% stratified sample of discharges from the nation's acute care community hospitals and comprises the largest available all-payer inpatient care database in the United States. The 2005 HCUP data

Rate of SSI

The 7 categories of surgical hospitalizations that we selected for analysis from the 2005 NIS database comprised a total of 723,490 hospitalizations (Table 1). Among this total number of cases, we identified 6891 cases of SSI for an overall rate of 9.5 cases per 1000 surgical hospitalizations or just under 1%. Projected to the national level, the 7 surgical categories accounted for an estimated 3,544,658 admissions with 33,846 cases involving SSI. Further detail on rates of SSI as observed in

Discussion

In the United States, administrative databases containing diagnosis and procedure codes are generated as a by-product of processing claims for reimbursement from third-party payers. These data are widely used for purposes other than payment, including health services research and quality of care assessment. Deficiencies in claims data when used in this manner have been widely described and include the fact that payment incentives can encourage providers to underreport or overreport particular

Conclusion

Measures to reduce rates of preventable SSI and their associated adverse outcomes will improve the safety and quality of care while avoiding substantial costs, thereby benefiting all consumers of health care. Change in Medicare payment policy eliminating additional payments for health care-associated infection underscores the urgent need for hospital leaders to address this important problem.

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    Financial support for this study was provided by ETHICON, Inc.

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    Copyright © 2009 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.