The financial burden of SSI is substantial and is one of the costliest of all hospital-acquired infections. Surg Infect (Larchmt). Preoperative Intranasal Decolonization with Topical Povidone-Iodine Antiseptic and the Incidence of Surgical Site Infection: A Review. 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. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material. Association of Postoperative Infection With Risk of Long-term Infection and Mortality. Telephone: (301) 427-1364, https://www.ahrq.gov/hai/pfp/haccost2017-results.html, AHRQ Publishing and Communications Guidelines, Healthcare Cost and Utilization Project (HCUP), Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase, Funding Opportunities Announcement Guidance, AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Public Access to Federally Funded Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, Comprehensive Unit-based Safety Program (CUSP), Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions, U.S. Department of Health & Human Services. Based on five studies reporting cost data, we estimated the additional cost for hospital-acquired SSI to be $28,219 (95% CI: $18,237 to $38,202), whereas excess mortality, based on three studies, was estimated at 0.026 (95% CI: 0.009 to 0.059) per HAC case (meaning for every 1,000 SSI cases, there are 26 excess deaths). Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diag- 2014 Jun;149(6):575-81. doi: 10.1001/jamasurg.2013.4663. Unable to load your collection due to an error, Unable to load your delegates due to an error. Background: Based on nine studies reporting cost data, we estimated the additional cost for hospital acquired CDI to be $17,260 (95% CI: $9,341 to $25,180), whereas excess mortality, based on 13 studies, was estimated at 0.044 (95% CI: 0.028 to 0.064) per HAC case (meaning for every 1,000 in-hospital CDI cases, there are 44 excess deaths). Review of current practice and guidelines. The studies varied by sample size (116,000 to 49 million), study period (1991 through 2011), study duration (3 years to 11 years), and data sources (one used National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, one used National Hospital Discharge Survey, and two used HCUP data). A surveillance system for maternal adverse events (not only for maternal mortality) would be helpful to understand the relationship between the adverse events and the associated outcome, including mortality and resource utilization. The preponderance of studies reporting on local data may limit the generalizability of estimates to the entire United States. Two studies used lab results, and one used the CDC-NHSN to define cases.42,47,48 CLABSI definitions used in cost studies also varied from clinical surveillance criteria to ICD-9-based definitions; however, these differences did not seem to influence the resulting attributable cost estimates. The economic costs of surgical site infection. We define additional cost as the incremental costs to the hospital for the inpatient stay attributable with the HAC of interest. The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district gen-eral hospital in England and the national burden imposed. Furthermore, databases such as HCUP-NIS may have limitations to clearly identify cases (e.g., some researchers stated that they cannot distinguish a condition acquired prior to or during hospitalization). Only studies of single hospitals or local hospital networks reported consequences of CLABSI for a general inpatient population. The study with the lowest cost estimate was also the most recent study, using data from 2006 through 2012.42 Overall, most of the studies included in meta-analysis focused on specific patient subpopulations including pediatric patients, intensive care unit patients, and those with specific conditions (e.g., epilepsy, cancer). This enabled them to use VAP definitions that incorporated clinical information such as laboratory testing that closely mirror the QSRS definitions. When this CI does not include zero, we can assume the HAC does have additional costs associated with its treatment above and beyond the costs for a hospital stay for similar patients without the HAC. In this section, we briefly discuss these considerations for each HAC. In 1970, the Centers for Disease Control and Prevention’s National Nosocomial Infection Surveillance (NNIS) … Aim: To assess, and evaluate the evidence for, the cost and health-related QoL (HRQoL) burden of SSIs across various surgical specialties in six European countries. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. On average, 6.4 studies were included in estimates for infectious HACs, whereas only an average of three studies were available for non-infectious HACs. We believe this is due to the low number of articles we were able to include. Schweizer ML, Cullen JJ, Perencevich EN, Vaughan Sarrazin MS. JAMA Surg. The least expensive infectious HAC is CAUTI ($13,793), and the most expensive is CLABSI ($48,108), although both had wide ranges of estimates in the literature and wide confidence intervals in our results. Prevention and treatment information (HHS). Compared to the other HACs studied, the cost literature for VAP is older. This site needs JavaScript to work properly. For this calculation, we took the number of inpatient deaths due to maternal adverse events (i.e., 134 as calculated earlier) and divided by the total number of inpatient maternal deaths in the United States. In 2018/19, 201 NHS hospitals and 8 Independent Sector (IS) NHS treatment centres submitted surveillance data for 132,254 surgical procedures to the PHE Surgical Site Infection (SSI) Surveillance Service; across 17 surgical categories 1,183 SSIs were FOIA The direct costs of SSI include a longer hospital stay, readmission, outpatient and emergency visits, further surgery, and prolonged antibiotic treatment. Conclusions: Cureus. Furthermore, SSIs constitute a financial burden and negatively impact on patient quality of life (QoL). The volume of literature, quality of studies, and relevance to our objectives varied for each of the HACs investigated. Eleven studies were included in our review for VTE. To estimate excess mortality, we combined the results of meta-analysis with estimates of underlying mortality in the population as shown in Exhibit 8. Coello R, Charlett A, Wilson J, Ward V, Pearson A, Borriello P. J Hosp Infect. J Hosp Infect. For instance, some studies involved all inpatient populations,37,42 yet the majority of studies focused on specific medical and/or surgical conditions (e.g., surgical oncology in Sammon 2013; colorectal resection in Byrn 2015).40,41 Additionally, the scope of the studies varied, from hospitals in a single network using data from EMRs40,42 to nationally representative samples, with four studies using HCUP-NIS,39,41,43,44 one using MedPAR claims,45 and one using Cardinal Health MedMined data.46 These factors potentially influenced our cost and mortality estimates, as exhibited in the large variations in individual estimates. Surgical site infections can sometimes be superficial infections involving the skin only. For example, one study that focused on Medicare beneficiaries and multiple drug classes reported a relative risk more than double that of studies involving all adults and one drug class.35. Dividing the number of pregnancy-related maternal deaths due to adverse events calculated in step one, by the total number of maternal adverse events calculated in step two, we arrive at an estimate of 0.005 (95% CI: 0.003 to 0.013) for excess mortality due to OBAE (meaning for every 1,000 OBAE cases, there are 5 excess deaths). Finally, few studies used clinical definitions of C. difficile infection and instead relied on ICD-9-based definitions, which may miss cases and may misclassify community-acquired cases as hospital-acquired. 2019 Nov 6;155(1):1-8. doi: 10.1001/jamasurg.2019.4539. Two of the cost studies and two mortality studies used national databases (HCUP-NIS); however, all four of these focused on specific patient subpopulations for analysis. Martin VT, Abdullahi Abdi M, Li J, Li D, Wang Z, Zhang X, Elodie WH, Yu B. Med Sci Monit. Agency for Healthcare Research and Quality, Rockville, MD. Importance Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators.. Methods used to calculate cost and/or mortality. Of note, this calculation assumes all OBAE-related deaths happen in the hospital setting, which, if not true, would mean excess mortality and percentage of inpatient maternal deaths due to OBAE are overestimates. A significant percentage of hospitalised patients contract a nosocomial infection, causing excess morbidity, mortality and healthcare-related costs. The sample size and standard error of individual study estimates ranged widely from 148 patients across 4 years39 to 670,767 patients across a 5-year study period.64 These differences were largely due to the source of data and the definition of population applied in each study and likely are the cause of the large confidence interval for our additional cost estimate (-$12,313 to $41,326). For instance, some studies involved all inpatient populations, whereas others focused on specific medical and/or surgical conditions (e.g., epilepsy in Mendizabal 2016, and surgical patients in Spector 2016).65,66 Given the evidence that the incidence of pressure ulcers increases with age,64 we performed a sensitivity analysis that excluded the pediatric study (Goudie 2015) and estimated the additional cost for hospital-acquired pressure ulcers among adult inpatients to be $12,712 ($278 to $25,145). The majority of studies in our analysis focused on specific patient subpopulations (e.g., trauma patients, cancer patients, those admitted for organ transplant). Based on seven studies reporting cost data, we estimated the additional cost for hospital-acquired CLABSI to be $48,108 (95% CI: $27,232 to $68,983), whereas excess mortality, based on five studies, was estimated at 0.15 (95% CI: 0.070 to 0.027) per HAC case (meaning for every 1,000 in-hospital CLABSI cases, there are 150 excess deaths). Among those conditions, hemorrhage/blood transfusion is the most commonly acquired condition (137 to 1,044 per 100,000 deliveries), followed by eclampsia/hypertensive complications (48 to 63 per 100,000 deliveries), and infection/sepsis (17 to 33 per 100,000 deliveries). Alfonso et al. Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals. The majority of VAP studies included in both cost and mortality estimates were conducted among ICU patients with only three studying patients outside of these units, one looking at cancer patients, and another examining all hospitalized patients.41,74,75 Two of the studies included in the mortality estimate reported on pediatric populations, one from a PICU and the other a NICU.76,77 Most VAP studies drew data from hospital medical records or databases that combined records from several hospitals. Attributable cost and extra length of stay of surgical site infection at a Ghanaian teaching hospital Infection Prevention in Practice, Vol. Patients in the included studies were mostly adult (ages >18), except for one that studied pediatric patients exclusively (ages 1–17 years),39 and another that studied patients of all ages, including patients younger than 18 years of age.54 All studies used nationwide data with five relying on HCUP-NIS. Rockville, MD 20857 1 2017 May;96(1):1-15. doi: 10.1016/j.jhin.2017.03.004. 2, No. These estimates do not include related costs (e.g., days of lost work) or costs of a readmission resulting from the HAC. Our search for recent literature on in-hospital falls in the United States returned very few results dealing with cost and/or mortality specifically for in-hospital events. In contrast, the literature contained far fewer usable studies for falls (3 for costs and 1 for mortality) and OBAE (2 for costs and none for mortality). Variability in individual study estimates. Most cases of healthcare-acquired surgical site infections (SSI) appear after discharge from hospital (); rates of postdischarge SSI between 2% and 14% have been reported ().Little is known of the costs of postdischarge SSI, but 2studies suggest that they are large (3–5) with health services and patients incurring costs and subsequent production losses. Background: Surgical site infections (SSIs) are associated with increased morbidity and mortality. Summary of meta-analysis additional cost estimates. Aim: To determine the clinical and economic burden of SSI over a two-year period and to predict the financial consequences of their elimination. In our final estimates, the number of studies included vary between HACs. The majority of SSIs are largely preventable and evidence-based strategies have been available for years and implemented in many hospitals. The combined direct and indirect costs of treating SSIs may be extremely high. Exhibit 7. Surgical site infection (SSI) continues to represent a significant portion of healthcare-associated infections because of their impact on morbidity, mortality, and cost of care. One study (by Bates, et.al) used for our cost estimate employed data from the late 1980s to the early 1990s.49 In addition, many more recent studies that address additional cost due to in-hospital falls base their costs calculations on the Bates article.49 Costs associated with prevention efforts, as well as direct and long-term costs of care after a fall that requires hospitalization, have been measured but are outside the scope of this analysis.50,51,52. Based on five studies reporting cost data, we estimated the additional cost for hospital-acquired SSI to be $28,219 (95% CI: $18,237 to $38,202), whereas excess mortality, based on three studies, was estimated at 0.026 (95% CI: 0.009 to 0.059) per HAC case (meaning for every 1,000 SSI cases, there are 26 excess deaths). 2001;47:198–209. Preventing Surgical Site Infections--Colon: Toolkit ... costs. Proportion of overall maternal deaths related to pregnancy: 38.2 percent (2011-2013 data). Objective: To determine the attributable costs associated with surgical site infection (SSI) following breast surgery. Total number of live-births: 3,978,497 (2015 data). Surgical Site Infections. Some of the factors we considered included: More details on each of the studies included in each estimate are provided in Appendix D. Forest plots for each additional cost and excess mortality meta-analysis for each HAC can be found in Appendix E. Based on two studies reporting cost data, we estimated the additional cost for hospital-acquired ADE to be $5,746 (95% CI: -$3,950 to $15,441), whereas excess mortality, based on six studies, was estimated at 0.012 (95% CI: 0.003 to 0.025) per HAC case (meaning for every 1,000 in-hospital ADE cases, there are 12 excess deaths). Based on two studies reporting cost data, we estimated the additional cost for hospital-acquired OBAE to be $602 (95% CI: -$578 to $1,782). *No studies could be used in our relative risk-based meta-analysis methods, so estimates were produced from an alternative method described in more detail in the OBAE section below. Data on falls related to other health care settings, such as nursing homes, were not included in our analysis. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. The HACs with the highest excess mortality were CLABSI and VAP. The 95% CI arises from a two-sided test of the hypothesis that the estimate of additional costs does not differ from a value of zero dollars. More robust literature and higher overall additional costs were found for infectious HACs compared to non-infectious HACs. This left us with only one study examining the risk of maternal mortality for adverse events acquired in hospitals, and the adverse event was obstetrical trauma only.54 Further, this study found no increase in mortality for obstetrical trauma. Summary of meta-analysis excess mortality estimates. The need to treat SSIs places a severe financial strain on health care resources. Adverse impact of surgical site infections in English hospitals. For example, no data on costs associated with infections were found, and such infections could be costly. Instead of reporting on mortality associated with maternal adverse events, most studies analyzed maternal adverse events as the end point. All patients in the considered studies were adult (ages >18) except for one, which studied pediatric patients exclusively (age 1–17 years)39 Although all studies reported sample size either in terms of number of cases or number of patients with CAUTI, we found wide ranges of sample sizes from 18 in 6-year pooled data on colorectal resection patients40 to 105,113 in 10-year pooled data on surgical oncology patients.41 These discrepancies were largely due to the source of data and definition of populations used in each study. We used meta-analysis to estimate the overall incidence rate for maternal adverse event as 688 (95% CI: 257 to1,118) per 100,000 deliveries. 2019 Oct 31;13(5):423-428. doi: 10.14444/6057. 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. 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. They also differed in the conditions that were counted as maternal adverse events (all four studies included infection/sepsis, hemorrhage/blood transfusion, and eclampsia/hypertensive complications; three studies included amniotic fluid embolisms and anesthesia complications; two studies included intracranial injuries and internal injuries of thorax, abdomen, and pelvis; one study included iatrogenic events. The most recent estimate comes from 2009, and two others date from prior to 2000.71,72,73 The two studies prior to 2000 reported the lowest attributable costs at $19,000 and $33,000. Study results that report hospital charges have been transformed to costs using cost-to-charge ratios, a well-established method in the literature.28 All costs are reported in 2015 dollar amounts and on a per-HAC-case basis. Surgical site infections (SSIs) are associated with excess morbidity and mortality. Another caution: we were only able to include studies involving the administration of opioids and, thus, this estimate may not be generalizable to anticoagulants, hypoglycemic agents, or adverse drug events involving other drug classes. Internet Citation: Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. reported that across multiple surgical specialties, the direct total healthcare cost of developing an SSI was $1,084,639, which was mainly attributable to prolonged hospitalization (37%) and other hospital costs (43%). Clipboard, Search History, and everyone in ambulatory surgery centers has role! 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