Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-20T05:22:21.719Z Has data issue: false hasContentIssue false
  • English
  • Français

Attributable Costs of Surgical Site Infection and Endometritis after Low Transverse Cesarean Delivery

Published online by Cambridge University Press:  02 January 2015

Margaret A. Olsen ,
Anne M. Butler ,
Denise M. Willers ,
Gilad A. Gross ,
Barton H. Hamilton  and
Victoria J. Fraser
Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Washington University, St. Louis, Missouri
Anne M. Butler
Affiliation:
Division of Infectious Diseases, Washington University, St. Louis, Missouri
Denise M. Willers
Affiliation:
Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri
Gilad A. Gross
Affiliation:
Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri
Barton H. Hamilton
Affiliation:
Washington University School of Medicine, and Olin Business School, Washington University, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University, St. Louis, Missouri
*
Div of Infectious Diseases, Washington University School of Medicine, Box 8051, 660 S Euclid Ave, St Louis, MO 63110 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Background.

Accurate data on costs attributable to hospital-acquired infections are needed to determine their economic impact and the cost-benefit of potential preventive strategies.

Objective.

To determine the attributable costs of surgical site infection (SSI) and endometritis (EMM) after cesarean section by means of 2 different methods.

Design.

Retrospective cohort.

Setting.

Barnes-Jewish Hospital, a 1,250-bed academic tertiary care hospital.

Patients.

There were 1,605 women who underwent low transverse cesarean section from July 1999 through June 2001.

Methods.

Attributable costs of SSI and EMM were determined by generalized least squares (GLS) and propensity score matched-pairs by means of administrative claims data to define underlying comorbidities and procedures. For the matched-pairs analyses, uninfected control patients were matched to patients with SSI or with EMM on the basis of their propensity to develop infection, and the median difference in costs was calculated.

Results.

The attributable total hospital cost of SSI calculated by GLS was $3,529 and by propensity score matched-pairs was $2,852. The attributable total hospital cost of EMM calculated by GLS was $3,956 and by propensity score matched-pairs was $3,842. The majority of excess costs were associated with room and board and pharmacy costs.

Conclusions.

The costs of SSI and EMM were lower than SSI costs reported after more extensive operations. The attributable costs of EMM calculated by the 2 methods were very similar, whereas the costs of SSI calculated by propensity score matched-pairs were lower than the costs calculated by GLS. The difference in costs determined by the 2 methods needs to be considered by investigators who are performing cost analyses of hospital-acquired infections.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 3 , March 2010 , pp. 276 - 282
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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.Herwaldt, LA, Cullen, JJ, Scholz, D, et al.A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections. Infect ControlHosp Epidemiol 2006;27:1291–1298.CrossRefGoogle ScholarPubMed
2.Weber, WP, Zwahlen, M, Reck, S, et al.Economic burden of surgical site infections at a European university hospital. Infect Control Hosp Epidemiol 2008;29:623–629.Google Scholar
3.Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725–730.CrossRefGoogle ScholarPubMed
4.Hollenbeak, CS, Murphy, D, Dunagan, WC, Fraser, VJ. Nonrandom selection and the attributable cost of surgical-site infections. Infect Control Hosp Epidemiol 2002;23:177–182.Google Scholar
5.Zoutman, D, McDonald, S, Vethanayagan, D. Total and attributable costs of surgical-wound infections at a Canadian tertiary care center. Infect Control Hosp Epidemiol 1998;19:254–259.CrossRefGoogle Scholar
6.Plowman, R, Graves, N, Griffin, MA, et al.The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. J Hosp Infect 2001;47:198–209.Google Scholar
7.Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Platt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196–203.CrossRefGoogle ScholarPubMed
8.McGarry, SA, Engemann, JJ, Schmader, K, Sexton, DJ, Kaye, KS. Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost. Infect Control Hosp Epidemiol 2004;25:461–467.Google Scholar
9.Anderson, DJ, Kirkland, KB, Kaye, KS, et al.Underresourced hospital infection control and prevention programs: penny wise, pound foolish? Infect Control Hosp Epidemiol 2007;28:767–773.Google Scholar
10.Kaye, KS, Anderson, DJ, Sloane, R, et al.The effect of surgical site infection on older operative patients. J Am Geriatr Soc 2009;57:46–54.CrossRefGoogle ScholarPubMed
11.Whitehouse, JD, Friedman, D, Kirkland, KS, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183–189.Google Scholar
12.Olsen, MA, Chu-Ongsakul, S, Brandt, KE, Dietz, JR, Mayfield, J, Fraser, VJ. Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg 2008;143:53–60.CrossRefGoogle ScholarPubMed
13.Jenney, AWJ, Harrington, GA, Russo, PL, Spelman, DW. Cost of surgical site infections following coronary artery bypass surgery. ANZ J Surg 2001;71:662–664.Google Scholar
14.Coskun, D, Aytac, J, Aydinli, A, Bayer, A. Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey. J Hosp Infect 2005;60:176–179.Google Scholar
15.Coello, R, Charlett, A, Wilson, J, Ward, V, Pearson, A, Borriello, P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect 2005;60:93–103.Google Scholar
16. Centers for Medicare and Medicaid Services. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates: payments for graduate education in certain emergency situations; changes to disclosure of physician ownership in hospitals and physician self-referral rules; updates to the long-term care prospective payment system; updates to certain IPPS-excluded hospitals; and collection of information regarding financial relationships between hospitals; final rule. 73 Fed Regist 48434–49083 (2008).Google Scholar
17.Graves, N, Weinhold, D, Tong, E, et al.Effect of healthcare-acquired infection on length of hospital stay and cost. Infect Control Hosp Epidemiol 2007;28:280–292.CrossRefGoogle ScholarPubMed
18.Graves, N, McGowan, JE JrNosocomial infection, the Deficit Reduction Act, and incentives for hospitals. JAMA 2008;300:1577–1579.CrossRefGoogle ScholarPubMed
19.Hirschhorn, LR, Currier, JS, Piatt, R. Electronic surveillance of antibiotic exposure and coded discharge diagnoses as indicators of postoperative infection and other quality assurance measures. Infect Control Hosp Epidemiol 1993;14:21–28.Google Scholar
20.Yokoe, DS, Noskin, GA, Cunningham, SM, et al.Enhanced identification of postoperative infections. Emerg Infect Dis 2004;10:1924–1930.CrossRefGoogle ScholarPubMed
21.Olsen, MA, Butler, AM, Willers, DM, Devkota, P, Gross, GA, Fraser, VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol 2008;29:477–484.CrossRefGoogle ScholarPubMed
22.Olsen, MA, Butler, AM, Willers, DM, Gross, GA, Devkota, P, Fraser, VJ. Risk factors for endometritis following low transverse cesarean section. Infect Control Hosp Epidemiol 2010;31:69–77.Google Scholar
23.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2004:1659–1702.Google Scholar
24. Agency for Healthcare Research and Quality. HCUP-US home page, http://www.hcup-us.ahrq.gov/. Accessed January 8, 2010.Google Scholar
25. US Department of Labor Bureau of Labor Statistics. Consumer price index. 2009. http://www.bls.gov/cpi/home.htm. Accessed August 14, 2009.Google Scholar
26.Wooldridge, JM. Introductory Econometrics: A Modern Approach. 2nd ed. Mason, OH: Thomson Learning, 2003.Google Scholar
27.Rubin, DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med 1997;127:757–763.Google Scholar
28.Rosenbaum, P, Rubin, D. The central role of the propensity score in observational studies for causal effects. Biometrika 1983;70:41–55.Google Scholar
29.Reilly, J, Twaddle, S, McIntosh, J, Kean, L. An economic analysis of surgical wound infection. J Hosp Infect 2001;49:245–249.Google Scholar
30.Mugford, M, Kingston, J, Chalmers, I. Reducing the incidence of infection after caesarean section: implications of prophylaxis with antibiotics for hospital resources. BMJ 1989;299:1003–1006.Google Scholar
31.Officer, LH, Williamson, SH. Measuring Worth exchange rate calculator. Computing “real value” over time with a conversion between UK pounds and US dollars, 1830 to present. 2009. http://www.measuringworth.com/calculators/exchange/result_exchange.php. Accessed August 17, 2009.Google Scholar
32.Chelmow, D, Hennesy, M, Evantash, EG. Prophylactic antibiotics for non-laboring patients with intact membranes undergoing cesarean delivery: an economic analysis. Am J Obstet Gynecol 2004;191:1661–1665.Google Scholar