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An Economic Model: Value of Antimicrobial-Coated Sutures to Society, Hospitals, and Third-Party Payers in Preventing Abdominal Surgical Site Infections

Published online by Cambridge University Press:  10 May 2016

Ashima Singh ,
Sarah M. Bartsch ,
Robert R. Muder  and
Bruce Y. Lee
Ashima Singh
Affiliation:
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Sarah M. Bartsch
Affiliation:
Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Robert R. Muder
Affiliation:
Division of Infectious Diseases, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania
Bruce Y. Lee*
Affiliation:
Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
*
Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, 855 North Wolfe Street, Suite 600, Baltimore, MD 21205 ([email protected]).
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Extract

Background

While the persistence of high surgical site infection (SSI) rates has prompted the advent of more expensive sutures that are coated with antimicrobial agents to prevent SSIs, the economic value of such sutures has yet to be determined.

Methods

Using TreeAge Pro, we developed a decision analytic model to determine the cost-effectiveness of using antimicrobial sutures in abdominal incisions from the hospital, third-party payer, and societal perspectives. Sensitivity analyses systematically varied the risk of developing an SSI (range, 5%–20%), the cost of triclosan-coated sutures (range, $5–$25/inch), and triclosan-coated suture efficacy in preventing infection (range, 5%–50%) to highlight the range of costs associated with using such sutures.

Results

Triclosan-coated sutures saved $4,109–$13,975 (hospital perspective), $4,133–$14,297 (third-party payer perspective), and $40,127–$53,244 (societal perspective) per SSI prevented, when a surgery had a 15% SSI risk, depending on their efficacy. If the SSI risk was no more than 5% and the efficacy in preventing SSIs was no more than 10%, triclosan-coated sutures resulted in extra expenditure for hospitals and third-party payers (resulting in extra costs of $1,626 and $1,071 per SSI prevented for hospitals and third-party payers, respectively; SSI risk, 5%; efficacy, 10%).

Conclusions

Our results suggest that switching to triclosan-coated sutures from the uncoated sutures can both prevent SSIs and save substantial costs for hospitals, third-party payers, and society, as long as efficacy in preventing SSIs is at least 10% and SSI risk is at least 10%.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 8 , August 2014 , pp. 1013 - 1020
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. 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(2):196–203.Google Scholar
2. Hawn, MT, Vick, CC, Richman, J, et al. Surgical site infection prevention: time to move beyond the surgical care improvement program. Ann Surg 2011;254(3):494–501. doi:10.1097/SLA.0b013e31822c6929.Google Scholar
3. Pastor, C, Artinyan, A, Varma, MG, Kim, E, Gibbs, L, Garcia-Aguilar, J. An increase in compliance with the Surgical Care Improvement Project measures does not prevent surgical site infection in colorectal surgery. Dis Colon Rectum 2010;53(1):24–30.Google Scholar
4. McHugh, SM, Collins, CJ, Corrigan, MA, Hill, AD, Humphreys, H. The role of topical antibiotics used as prophylaxis in surgical site infection prevention. J Antimicrob Chemother 2011;66(4):693–701.Google Scholar
5. Watanabe, A, Kohnoe, S, Shimabukuro, R, et al. Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery. Surg Today 2008;38(5):404–412.Google Scholar
6. de Oliveira, AC, Ciosak, SI, Ferraz, EM, Grinbaum, RS. Surgical site infection in patients submitted to digestive surgery: risk prediction and the NNIS risk index. Am J Infect Control 2006;34(4):201–207.Google Scholar
7. Blumetti, J, Luu, M, Sarosi, G, et al. Surgical site infections after colorectal surgery: do risk factors vary depending on the type of infection considered? Surgery 2007;142(5):704–711.Google Scholar
8. Rahbari, NN, Knebel, P, Diener, MK, et al. Current practice of abdominal wall closure in elective surgery: is there any consensus? BMC Surg 2009;9:8.Google Scholar
9. Alexander, JW, Kaplan, JZ, Altemeier, WA. Role of suture materials in the development of wound infection. Ann Surg 1967;165(2):192–199.Google Scholar
10. Kobayashi, S, Ito, M, Sugito, M, Kobayashi, A, Nishizawa, Y, Saito, N. Association between incisional surgical site infection and the type of skin closure after stoma closure. Surg Today 2011;41(7):941–945.Google Scholar
11. Baracs, J, Huszár, O, Sajjadi, SG, Horváth, ÖP. Surgical site infections after abdominal closure in colorectal surgery using triclosan-coated absorbable suture (PDS Plus) vs. uncoated sutures (PDS II): a randomized multicenter study. Surg Infect (Larchmt) 2011;12(6):483–489.Google Scholar
12. Rašić, Ž, Schwarz, D, Adam, VN, et al. Efficacy of antimicrobial triclosan-coated polyglactin 910 (Vicryl* Plus) suture for closure of the abdominal wall after colorectal surgery. Coll Antropol 2011;35(2):439–443.Google Scholar
13. Justinger, C, Moussavian, MR, Schlueter, C, Kopp, B, Kollmar, O, Schilling, MK. Antibacterial coating of abdominal closure sutures and wound infection. Surgery 2009;145(3):330–334.Google Scholar
14. Justinger, C, Schuld, J, Sperling, J, Kollmar, O, Richter, S, Schilling, MK. Triclosan-coated sutures reduce wound infections after hepatobiliary surgery: a prospective non-randomized clinical pathway driven study. Langenbecks Arch Surg 2011;396(6):845–850.Google Scholar
15. Mingmalairak, C, Ungbhakorn, P, Paocharoen, V. Efficacy of antimicrobial coating suture coated polyglactin 910 with triclosan (Vicryl Plus) compared with polyglactin 910 (Vicryl) in reduced surgical site infection of appendicitis, double blind randomized control trial, preliminary safety report. J Med Assoc Thail 2009;92(6):770–775.Google Scholar
16. Rozzelle, CJ, Leonardo, J, Li, V. Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective, double-blinded, randomized controlled trial. J Neurosurg Pediatr 2008;2(2):111–117.Google Scholar
17. Williams, N, Sweetland, H, Goyal, S, Ivins, N, Leaper, DJ. Randomized trial of antimicrobial-coated sutures to prevent surgical site infection after breast cancer surgery. Surg Infect (Larchmt) 2011;12(6):469–474.Google Scholar
18. Chen, SY, Chen, TM, Dai, NT, et al. Do antibacterial-coated sutures reduce wound infection in head and neck cancer reconstruction? Eur J Surg Oncol 2011;37(4):300–304.Google Scholar
19. Isik, I, Selimen, D, Senay, S, Alhan, C. Efficiency of antibacterial suture material in cardiac surgery: a double-blind randomized prospective study. Heart Surg Forum 2012;15(1):E40–E45.Google Scholar
20. Stadler, S, Fleck, T. Triclosan-coated sutures for the reduction of sternal wound infections? a retrospective observational analysis. Interact Cardiovasc Thorac Surg 2011;13(3):296–299.Google Scholar
21. Thimour-Bergström, L, Roman-Emanuel, C, Scherstén, H, Friberg, Ö, Gudbjartsson, T, Jeppsson, A. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial. Eur J Cardiothorac Surg 2013;44(5):931–938.Google Scholar
22. Nakamura, T, Kashimura, N, Noji, T, et al. Triclosan-coated sutures reduce the incidence of wound infections and the costs after colorectal surgery: a randomized controlled trial. Surgery 2013;153(4):576–583.Google Scholar
23. Alexander, JW, Rahn, R, Goodman, HR. Prevention of surgical site infections by an infusion of topical antibiotics in morbidly obese patients. Surg Infect (Larchmt) 2009;10(1):53–57.Google Scholar
24. Millbourn, D, Cengiz, Y, Israelsson, LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg 2009;144(11):1056–1059.Google Scholar
25. 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(2):93–103.Google Scholar
26. Astagneau, P, Rioux, C, Golliot, F, Brucker, G. Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect 2001;48(4):267–274.Google Scholar
27. Fukuda, H, Morikane, K, Kuroki, M, et al. Impact of surgical site infections after open and laparoscopic colon and rectal surgeries on postoperative resource consumption. Infection 2012;40(6):649–659.Google Scholar
28. Merle, V, Germain, JM, Chamouni, P, et al. Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol. Am J Infect Control 2000;28(2):109–115.Google Scholar
29. Savarese, DMF, Zand, JM. UpToDate drug information. Wolters Kluwer Health, 2013.Google Scholar
30. Truven Health Analytics. Micromedex solutions. http://www.micromedexsolutions.com/micromedex2/librarian. Accessed 2013.Google Scholar
31. MMS. A regional distributor with a national presence. http://www.mmsmedical.com.Google Scholar
32. Whitehall Group. Medical and dental supplies. http://twgmedicalsupplies.com.Google Scholar
33. Agency for Healthcare Research and Quality, US Department of Health and Human Services. HCUPnet. National and regional estimates on hospital use for all patients from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) 2010 (see “National Statistics on All Stays”). http://hcupnet.ahrq.gov. Accessed March 2013.Google Scholar
34. American Medical Association. CPT code/relative value search. 2012. https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do. Accessed February, 2013.Google Scholar
35. Physicians’ Desk Reference staff. Red Book: Pharmacy’s Fundamental Reference. Montvale, NJ: Thompson Reuters (Healthcare), 2010.Google Scholar
36. Gould, MK, Dembitzer, AD, Sanders, GD, Garber, AM. Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A cost-effectiveness analysis. Ann Intern Med 1999;130(10):789–799.Google Scholar
37. Human Mortality Database. University of California, Berkeley (USA), and Max Planck Institute for Demographic Research (Germany); 2008. http://www.mortality.org.Google Scholar
38. Bureau of Labor Statistics. Occupational employment statistics: May 2011 National Occupational Employment and Wage Estimates, United States. 2013. http://www.bls.gov/oes/current/oes_nat.htm#00-0000. Accessed February 2013.Google Scholar
39. Ceydeli, A, Rucinski, J, Wise, L. Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg 2005;62(2):220–225.Google Scholar
40. Israelsson, LA, Jonsson, T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg 1993;80(10):1284–1286.Google Scholar
41. Shorr, AF, Tabak, YP, Killian, AD, Gupta, V, Liu, LZ, Kollef, MH. Healthcare-associated bloodstream infection: a distinct entity? insights from a large U.S. database. Crit Care Med 2006;34(10):2588–2595.Google Scholar
42. Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10(4):561–566.Google Scholar
43. Graves, N, Halton, K, Lairson, D. Economics and preventing hospital-acquired infection: broadening the perspective. Infect Control Hosp Epidemiol 2007;28(2):178–184.Google Scholar
44. Belizon, A, Balik, E, Feingold, DL, et al. Major abdominal surgery increases plasma levels of vascular endothelial growth factor: open more so than minimally invasive methods. Ann Surg 2006;244(5):792–798.Google Scholar
45. Friberg, O, Dahlin, LG, Levin, LA, et al. Cost effectiveness of local collagen-gentamicin as prophylaxis for sternal wound infections in different risk groups. Scand Cardiovasc J 2006;40(2):117–125.Google Scholar
46. Horiuchi, T, Tanishima, H, Tamagawa, K, et al. Randomized, controlled investigation of the anti-infective properties of the Alexis retractor/protector of incision sites. J Trauma 2007;62(1):212–215.Google Scholar
47. Yurko, Y, McDeavitt, K, Kumar, RS, et al. Antibacterial mesh: a novel technique involving naturally occurring cellular proteins. Surg Innov 2012;19(1):20–26.Google Scholar
48. Alexander, JW, Solomkin, JS, Edwards, MJ. Updated recommendations for control of surgical site infections. Ann Surg 2011;253(6):1082–1093.Google Scholar
49. Dubas, ST, Wacharanad, S, Potiyaraj, P. Tunning of the antimicrobial activity of surgical sutures coated with silver nanoparticles. Colloids Surf A 2011;380(1–3):25–28.Google Scholar
50. Chang, WK, Srinivasa, S, Morton, R, Hill, AG. Triclosan-impregnated sutures to decrease surgical site infections: systematic review and meta-analysis of randomized trials. Ann Surg 2012;255(5):854–859.Google Scholar
51. Wang, ZX, Jiang, CP, Cao, Y, Ding, YT. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg 2013;100(4):465–473.Google Scholar
52. Gervaz, P, Bandiera-Clerc, C, Buchs, NC, et al. Scoring system to predict the risk of surgical-site infection after colorectal resection. Br J Surg 2012;99(4):589–595.Google Scholar
53. van Walraven, C, Musselman, R. The surgical site infection risk score (SSIRS): a model to predict the risk of surgical site infections. PLoS ONE 2013;8(6):e67167.Google Scholar
54. Urban, JA. Cost analysis of surgical site infections. Surg Infect (Larchmt) 2006;7(Suppl 1):S19–S22.Google Scholar
55. Ford, HR, Jones, P, Gaines, B, Reblock, K, Simpkins, DL. Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL plus antibacterial suture (coated polyglactin 910 suture with triclosan) with coated VICRYL suture (coated polyglactin 910 suture). Surg Infect (Larchmt) 2005;6(3):313–321.CrossRefGoogle ScholarPubMed
56. Yazdankhah, SP, Scheie, AA, Hoiby, EA, et al. Triclosan and antimicrobial resistance in bacteria: an overview. Microb Drug Resist 2006;12(2):83–90.Google Scholar
57. Chuanchuen, R, Beinlich, K, Hoang, TT, Becher, A, Karkhoff-Schweizer, RR, Schweizer, HP. Cross-resistance between triclosan and antibiotics in Pseudomonas aeruginosa is mediated by multidrug efflux pumps: exposure of a susceptible mutant strain to triclosan selects nfxB mutants overexpressing MexCD-OprJ. Antimicrob Agents Chemother 2001;45(2):428–432.Google Scholar
58. Birošová, L, Mikulášová, M. Development of triclosan and antibiotic resistance in Salmonella enterica serovar Typhimurium. J Med Microbiol 2009;58(4):436–441.Google Scholar
59. Lee, BY. Digital decision making: computer models and antibiotic prescribing in the twenty-first century. Clin Infect Dis. 2008;46(8):1139–1141.Google Scholar
60. Lee, BY, Biggerstaff, BJ. Screening the United States blood supply for West Nile virus: a question of blood, dollars, and sense. PLoS Med 2006;3(2):e99. doi:10.1371/journal.pmed.0030099.Google Scholar