Surgical site infections in patients in Veterans Affairs hospitals are associated with excessive costs, especially in patients undergoing neurosurgery, according to study results.
Researchers used Veterans Health Administration Decision Support System and Veterans Affairs (VA) Surgical Quality Improvement Program databases to assess costs associated with surgical site infections (SSIs) among VA patients who had surgery in fiscal year 2010. Researchers included costs of the index hospitalization and subsequent 30-day readmissions, and evaluated incremental costs associated with SSIs, controlling for surgical and patient risk factors and hospital cost variations. Potential cost savings of quality improvement programs to reduce SSI rates at hospitals were determined by additional analysis with the highest risk-adjusted SSI rates.
According to study results, 3.2% of VA patients who underwent surgery experienced an SSI; 0.8% had a deep SSI and 2.4% had a superficial SSI. For patients without an SSI, the mean unadjusted cost was $31,580 compared with $52,620 for patients with an SSI. Researchers found the relative costs in the risk-adjusted analyses were 1.43 times greater among patients with an SSI vs. patients without an SSI, whereas deep SSIs were associated with 1.93 times greater costs and superficial SSIs with a 1.25 times greater costs.
When looking at highest-volume specialties, study results showed patients undergoing neurosurgery had the greatest mean cost attributable to SSIs at $23,755, followed by patients undergoing orthopedic surgery, general surgery, peripheral vascular surgery and urologic surgery. Overall, the Veterans Health Administration would save approximately $6.7 million per year if hospitals in the highest 10th percentile reduced their SSI rates to the rates of hospitals in the 50th percentile.
“In conclusion, SSIs are associated with a significant increase in attributable postsurgical costs, even after adjusting for patients-level, surgical-level and facility-level factors,” the researchers wrote. “These increases in costs were highest among deep SSIs and SSIs among neurosurgery patients. Hospital administrators, policy makers, surgeons and hospital epidemiologists can use these data to make a business case for quality improvement efforts focused on SSIs.”
For more information:
Schweizer ML. JAMA Surg. 2014;doi:10.1001/jamasurg.2013.4663.
Disclosure: The researchers have no relevant financial disclosures.