The impact of surgical site infection on hospitalisation, treatment costs, and health-related quality of life after vascular surgery

Abstract

Surgical site infections (SSI) substantially increase costs for healthcare providers because of additional treatments and extended patient recovery. The objective of this study was to assess the cost and health-related quality of life impact of SSI, from the perspective of a large teaching hospital in England. Data were available for 144 participants undergoing clean or clean-contaminated vascular surgery. SSI development, length of hospital stay, readmission, and antibiotic use were recorded over a 30-day period. Patient-reported EQ-5D scores were obtained at baseline, day 7 and day 30. Linear regressions were used to control for confounding variables. A mean SSI-associated length of stay of 9.72 days resulted in an additional cost of £3776 per patient (including a mean antibiotic cost of £532). Adjusting for age, smoking status, and procedure type, SSI was associated with a 92% increase in length of stay (P < 0.001). The adjusted episode cost was £3040. SSI reduced patient utility between baseline and day 30 by 0.156 (P = 0.236). Readmission rates were higher with SSI (P = 0.017), and the rate to return to work within 90 days was lower. Therefore, strategies to reduce the risk of surgical site infection for high-risk vascular patients should be investigated.

Keywords: cost; health-related quality of life; infection; regression; vascular surgery.

FIGURE 1

Linear model predicted effect of SSI on the length of stay in hospital. Mean length of stay (LOS) in patients with SSI or no SSI within 30 days of surgery was assessed using a linear model. Model coefficients for the final linear model are presented in Supplementary Table S2. The results show that those with an SSI with 30 days of surgery have a significantly longer LOS compared with those without an SSI (P < 0.001). The data are presented as the mean ± 95% confidence interval from 107 and 29 individual patients. The model prediction was generated considering a patient aged 62.8 years old, who had never smoked and who had open surgery on the aorta/ileac vessels

FIGURE 2

Linear model predicted effect of SSI on utility at baseline, day 7 and day 30. Mean utility in patients with SSI or no SSI within 30 days of surgery was assessed using a linear model at days 0, 7 and 30. Model coefficients for the final linear models are presented in Supplementary Table S4. The results show a non‐significant trend of reduction in utility score over time in those with SSI compared with those without SSI. The data are presented as the mean ± 95% confidence interval from 73 and 18 individual patients at baseline, 59 and 8 individual patients at day 7 and 52 and 9 individual patients at day 30. The model predictions were generated using the mean baseline utility for day 7 and day 30 predictions