Surgical site infections (SSI) affect 2-3% of patients who undergo surgery. SSIs usually occur due to bacteria and/or other microbes infecting the site of surgery due to improper preparation for the surgery and/or poor care of wounds post-surgery. Healthcare workers take extra precautions to prevent SSIs and subsequent complications.
The rate of surgical site infections is showing an increase in recent decades because of an increase in reporting, longer average life spans, and the presence of antibiotic-resistant bacteria1. Due to this increasing rate and varying degrees of severity of SSI, an important question to ask is: What is the cost of surgical site infections to the healthcare system?
The healthcare system incurs large costs due to SSI. According to an investigative study written by scholar and orthopedic surgeon Joshua A. Urban: “Surgical site infections may account for as much as $10 billion annually in direct and indirect medical costs”. Another study conducted by economist R. Douglas Scott II stated that healthcare-associated infections (HAI), of which SSIs are a subset of, accounted for $4.5 billion in 1992—this number has since grown2. Direct costs include hospital visits, readmission, additional surgery etc. Indirect costs include post-care costs like lost wages, loss of functional capacity, and loss of mental health. An experimental study conducted in the United States resulted in a $3382 average cost per SSI1. This study also took into account costs and conditions outside of the hospital and cited “[…] shortened postoperative stays, as well as outpatient and same-day surgery […]” as factors increasing the risk of SSI1. A similar study conducted in Canada yielded an average cost of $3383. It is important to highlight the varying degrees of severity for a surgical site infection. Some are superficial and can be treated with wound draining and cleaning therefore exhibiting less of an economic cost. However, some SSIs are severe and require additional surgery and can even affect internal organs—these SSIs exhibit a high economic cost.
Joshua A. Urban also investigated several studies relating to more serious surgical site infection cases. Cost analysis of patients who underwent “coronary artery bypass grafting or cardiac valve surgery” resulted in costs between $14,000 and $20,000.1 Another cost analysis for patients at the Hospital for Special Surgery in New York who developed infections in joint arthroplasties yielded results that “exceeded the Medicare reimbursement by $27,000 and the private insurance reimbursement by $18,000”. This caused this hospital to lose somewhere between $1.2 million and $1.4 million. If these costs are similar in hospitals around the world, it is evident that severe SSIs cost the healthcare system millions or even billions of dollars.
Surgical site infections are often easily preventable either with proper preparation before surgery or proper care after surgery. Additionally quick diagnosis and treatment of an SSI can prevent it from developing into a more serious condition. However, with the rise of antibiotic-resistant bacteria, new and innovative methods and technologies must be explored and implemented to treat the abundance of SSIs in hospitals. This in combination with proper protocol and precautions with healthcare-workers may reduce the frequency and severity of SSIs significantly.
1Urban, Joshua A. “Cost Analysis of Surgical Site Infections.” Surgical Infections 7, no. 1 (2006). 2006. Accessed June 16, 2016. doi:10.1089/sur.2006.7.s1-19.
2Scott, R. Douglous, II. “The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention.” The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, March 2009. March 2009. https://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf.
Surg Infect (Larchmt). 2006;7 Suppl 1:S19-22.
Cost analysis of surgical site infections.
Department of Orthopaedics, Nebraska Orthopaedic Associates, Omaha, Nebraska 68118, USA. firstname.lastname@example.org
Patients with surgical site infections (SSIs) require a longer time in the hospital, more nursing care, additional dressings, and, possibly, readmission to the hospital and further surgery. The combined direct and indirect costs of treating SSIs may be extremely high.
Review of current practice and guidelines.
The direct costs of SSI include a longer hospital stay, readmission, outpatient and emergency visits, further surgery, and prolonged antibiotic treatment. Other direct costs arise from radiologic procedures, laboratory tests, home health visits and other ancillary services, drugs, and professional fees. Indirect costs, which are difficult to quantify, include lost productivity of the patient and family and a temporary or permanent decline in functional or mental capacity. The cost of SSIs increases with the depth of the infection. That is, the costs associated with superficial incisional SSIs are relatively low, but increase with deep SSI, and especially when organ or space infection is present. The estimated costs of managing SSI differ widely, from less than dollar 400 per case for superficial SSI to more than dollar 30,000 per case for serious organ or space infections.
The need to treat SSIs places a severe financial strain on health care resources. It is possible that treating high-risk surgical patients medically will prove to be more cost-effective than repeated operations.
Reducing Surgical Site Infections: A Review
This article has been cited by other articles in PMC.
Infection at or near surgical incisions within 30 days of an operative procedure contributes substantially to surgical morbidity and mortality each year. The prevention of surgical site infections encompasses meticulous operative technique, timely administration of appropriate preoperative antibiotics, and a variety of preventive measures aimed at neutralizing the threat of bacterial, viral, and fungal contamination posed by operative staff, the operating room environment, and the patient’s endogenous skin flora. It is the latter aspect of contamination, and specifically mechanical methods of prevention, on which this review focuses.
Key words: Surgical site infections, Postsurgical infection, Surgery, patient skin preparation, Povidone iodine, Chlorhexidine, Isodine povacrylex, Isopropyl alcohol
Infection at or near surgical incisions within 30 days of an operative procedure, dubbed surgical site infection, contributes substantially to surgical morbidity and mortality each year. Surgical site infection (SSI) accounts for 15% of all nosocomial infections and, among surgical patients, represents the most common nosocomial infection.1 Postsurgical infection leads to increased length of postoperative hospital stay, drastically escalated expense, higher rates of hospital readmission, and jeopardized health outcomes. Accordingly, the first step in the treatment of SSIs is in their prevention. This encompasses meticulous operative technique, timely administration of appropriate preoperative antibiotics, and a variety of preventive measures aimed at neutralizing the threat of bacterial, viral, and fungal contamination posed by operative staff, the operating room environment, and the patient’s endogenous skin flora. It is this latter aspect of contamination, and specifically mechanical methods of prevention, on which this review focuses.
Definition of SSI
There are 3 different types of surgical site infection defined by the Centers for Disease Control and Prevention (CDC).2 In the criteria put forth by the CDC, SSIs are classified as either incisional or organ/space, with incisional SSIs being further subclassified as superficial (involving only skin and subcutaneous tissue) versus deep (involving underlying soft tissue). Table 1 further elaborates on the CDC classification system, which has been widely adopted by surveillance and surgical personnel.
Centers for Disease Control and Prevention Surgical Site Infection (SSI) Classification System
Cost of SSIs
Surgical site infections raise costs due to prolonged hospitalization, additional diagnostic tests, therapeutic antibiotic treatment, and, rarely, additional surgery.3 In 2009, it was estimated that SSI extended the length of hospital stay on average by 9.7 days and increased costs by $20,842 per admission; this amounts to additional hospital costs exceeding $900 million, with hospital readmission due to SSI accounting for an additional $700 million in health care spending.4 Deep SSIs tend to raise costs more than superficial infection.5 A recent study synthesizing the results of 16 various studies examining the cost of SSIs revealed a mean increase of 115% for the cost of care of a patient with an SSI as compared with noninfected control subjects