Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-22T12:38:58.921Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

James D. Whitehouse ,
N. Deborah Friedman ,
Kathryn B. Kirkland ,
William J. Richardson  and
Daniel J. Sexton
James D. Whitehouse
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
N. Deborah Friedman
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Kathryn B. Kirkland
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
William J. Richardson
Affiliation:
Division of Orthopedic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
*
Division of Infectious Diseases, Duke University Medical Center, Box 3605, Durham, NC 27710
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To measure the impact of orthopedic surgical-site infections (SSIs) on quality of life, length of hospitalization, and cost.

Design:

A pairwise-matched (1:1) case-control study within a cohort.

Setting:

A tertiary-care university medical center and a community hospital.

Patients:

Cases of orthopedic SSIs were prospectively identified by infection control professionals. Matched controls were selected from the entire cohort of patients undergoing orthopedic surgery who did not have an SSI. Matching variables included type of surgical procedure, National Nosocomial Infections Surveillance risk index, age, date of surgery, and surgeon.

Main Outcome Measures:

Quality of life, duration of postoperative hospital stay, frequency of hospital readmission, overall direct medical costs, and mortality rate.

Results:

Fifty-nine SSIs were identified. Each orthopedic SSI accounted for a median of 1 extra day of stay during the initial hospitalization (P = .001) and a median of 14 extra days of hospitalization during the follow-up period (P = .0001). Patients with SSI required more rehospitalizations (median, 2 vs 1; P = .0001) and more total surgical procedures (median, 2 vs 1; P = .0001). The median total direct cost of hospitalizations per infected patient was $24,344, compared with $6,636 per uninfected patient (P = .0001). Mortality rates were similar for cases and controls. Quality of life was adversely affected for patients with SSI. The largest decrements in scores on the Medical Outcome Study Short Form 36 questionnaire were seen in the physical functioning and role-physical domains.

Conclusions:

Orthopedic SSIs prolong total hospital stays by a median of 2 weeks per patient, approximately double rehospitalization rates, and increase healthcare costs by more than 300%. Moreover, patients with orthopedic SSIs have substantially greater physical limitations and significant reductions in their health-related quality of life.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 4 , April 2002 , pp. 183 - 189
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.CrossRefGoogle ScholarPubMed
2.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159–167.CrossRefGoogle Scholar
3.Horan, TC, Culver, DH, Gaynes, RP, Jarvis, WR, Edwards, JR, Reid, CR. Nosocomial infections in surgical patients in the United States, January 1986-June 1992. Infect Control Hosp Epidemiol 1993;14:73–80.CrossRefGoogle ScholarPubMed
4.Green, JW, Wenzel, RP. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg 1977;185:264–268.CrossRefGoogle ScholarPubMed
5.Brachman, PS, Dan, BB, Haley, RW, Hooton, TM, Garner, JS, Allen, JR. Nosocomial surgical infections: incidence and cost. Surg Clin North Am 1980;60:15–25.CrossRefGoogle ScholarPubMed
6.Scheckler, WE. Nosocomial infections in a community hospital, 1972 through 1976. Arch Intern Med 1978;138:1792–1794.CrossRefGoogle Scholar
7.Taylor, GD, Kirkland, TA, McKenzie, MM, Sutherland, B, Weins, RM. The effect of surgical wound infection on postoperative hospital stay. Can J Surg 1995;38:149–153.Google ScholarPubMed
8.Vegas, AA, Jodra, VM, Garcia, ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 1993;9:504–510.Google Scholar
9.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
10.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infection, 1992: a modification of the CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.Google Scholar
11.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(suppl 3B):152S–157S.Google Scholar
12.Delgado-Rodriguez, M, Sillero-Arenas, M, Medina-Cuadros, M, Martinez-Gallego, G. Nosocomial infections in surgical patients: comparison of two measures of intrinsic patient risk. Infect Control Hosp Epidemiol 1997;18:19–23.Google Scholar
13.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.CrossRefGoogle ScholarPubMed
14.Stucki, G, Liang, MH, Phillips, C, Katz, JN. The Short Form-36 is preferable to the SIP as a generic health status measure in patients undergoing elective total hip arthroplasty. Arthritis Care and Research 1995;8:174–181.Google Scholar
15.Ware, JE, Sherbourne, CD. The MOS 36-item short form health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992;30:473–183.CrossRefGoogle ScholarPubMed
16.Stewart, AL, Greenfield, S, Hays, RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcomes Study. JAMA 1989;262:907–913.Google Scholar
17.McHorney, CA, Ware, JE, Raczek, AE. The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993; 31:247–263.Google Scholar
18.McHorney, CA, Ware, JE, Rogers, W, Raczek, AE, Lu, JF. The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts: results from the Medical Outcomes Study. Med Care 1992;30:(suppl 5):MS253–MS265.CrossRefGoogle Scholar
19.Ware, JE, Snow, KK, Kosinski, M, Gandek, B. SF-36 Health Survey: Manual and Interpretation Guide. Boston: The Health Institute; 1993.Google Scholar
20.Kiebzak, GM, Vain, PA, Gregory, AM, Mokris, JG, Mauerhan, DR. SF-36 General Health Status Survey to determine patient satisfaction at short-term follow-up after total hip and knee arthroplasty. J South Orthop Assoc 1997;6:169–172.Google ScholarPubMed
21. 1996 National Nosocomial Infections Surveillance System (NNIS) Conference for Hospitals Participating in the National Infections Surveillance. SSI Rates, by Operative Procedure and Risk Index Category, October 1986-July 1996. Atlanta, GA: Centers for Disease Control and Prevention; 1996.Google Scholar
22.Calderone, RR, Garland, DE, Capen, DA, Oster, H. Cost of medical care for postoperative spinal infections. Orthop Clin North Am 1996;27:171–182.CrossRefGoogle ScholarPubMed
23.Hebert, CK, Williams, RE, Levy, RS, Barrack, RL. Cost of treating an infected total knee replacement. Clin Orthop 1996;331:140–145.Google Scholar
24.Sculco, TP. The economic impact of infected joint arthroplasty. Orthopedics 1995;18:871–873.Google Scholar
25.Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281–286.Google Scholar
26.Kreibich, DN, Vaz, M, Bourne, RB, et al. What is the best way of assessing outcome after total knee replacement? Clin Orthop 1996;331:221–225.Google Scholar
27.McGuigan, FX, Hozack, WJ, Moriarty, L, Eng, K, Rothman, RH. Predicting quality-of-life outcomes following total joint arthroplasty: limitations of the SF-36 health status questionnaire. Journal of Arthroplasty 1995;10:742–747.CrossRefGoogle ScholarPubMed
28.Calderone, RR, Thomas, JC Jr, Haye, W, Abeles, D. Outcome assessment in spinal infections. Orthop Clin North Am 1996;27:201–205.CrossRefGoogle ScholarPubMed
29.Kantz, ME, Harris, WJ, Levitsky, K, Ware, JE, Davis, AR. Methods for assessing condition-specific and generic functional status outcomes after knee replacement. Med Care 1992;30(suppl 5):MS240–MS252.CrossRefGoogle ScholarPubMed
30.Liang, MH, Larson, MG, Cullen, KE, Schwartz, JA. Comparative measurement of efficiency and sensitivity of five health status instruments for arthritis research. Arthritis Rheum 1985;28:542–547.Google Scholar
31.Bombardier, C, Melfi, CA, Paul, J, et al. Comparison of a generic and disease-specific measure of pain and physical function after knee replacement surgery. Med Care 1995;33:AS131–AS144.Google ScholarPubMed
32.Gertman, PM, Restuccia, JD. The appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care. Med Care 1981;19:855–871.CrossRefGoogle ScholarPubMed
33.Wakefield, DS, Pfaller, MA, Hammons, GT, Massanari, RM. The use of the appropriateness evaluation protocol for estimating the incremental costs associated with nosocomial infections. Med Care 1987;25:481–488.Google Scholar
34.Went, P, Krismer, M, Frischhut, B. Recurrence of infection after revision of infected hip arthroplasties. J Bone Joint Surg 1995;77:307–309.CrossRefGoogle ScholarPubMed
35.Holtz, TH, Wenzel, RP. Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control 1992; 20:206–213.Google Scholar
36.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.Google Scholar