A report from the National Nosocomial Infections Surveillance (NNIS) System. Therefore, approximately $1,409 (42%) of all costs attributable to SSI were unknown to the index hospital. What is the impact of surgical site infections? The questionnaire contained three sections. They occur an estimated 160,000 to 300,000 times per year and account for more than 20% of all HAIs. Signs and symptoms of surgical site infections Any SSI may cause redness, delayed healing, fever, pain, tenderness, warmth, or swelling. The most relevant postoperative complication is surgical site infection (SSI) because of its impact on patient outcomes and enormous treatment costs. No patients in our study died during the 8-week postdischarge follow-up period. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Fingerprint Dive into the research topics of 'Financial impact of surgical site infections on hospitals: The hospital management perspective'. Surgical site infections (SSI) substantially increase costs for healthcare providers because of additional treatments and extended patient recovery. After the conversion of charges to costs, an SSI diagnosed after discharge was associated with excess costs of $2,573 ($3,489 minus $916) from rehospitalization across the entire population who developed an SSI, regardless of readmission status. The costs of adverse drug events in hospitalized patients. To determine if preexisting conditions could account for some of the costs associated with SSI recognized after discharge, we used a matched linear regression model; the calculated chronic disease score was the predictor for log-transformed total costs (Table 5). Student t test, Wilcoxon rank-sum test, or Fisher exact test were used, where appropriate, for univariate comparisons. This database provided the standard wholesale costs for all antibiotic prescriptions for the 8-week postoperative period. Article Google Scholar 10. During the anticipated study period, 3,000 surgeries would be estimated to be performed and, given a 2.8% risk for infection beginning after discharge from the hospital (based on our prior observations), 84 SSIs would be recognized after discharge. Costs and outcomes secondary to SSIs can vary by location and surgery type. Twice as many case-patients required a stay in a skilled nursing facility (9% vs. 4.5%, p=0.09). Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Statistical analyses were performed with SAS v 8.01 for Windows (SAS Institute, Inc., Cary, NC). The Centers for Medicare and Medicaid Services require hospitals to report SSI rates, which are publicly disseminated (along with other surgical quality measures) on its Hospital Compare website. The price of a surgical-site infection: more than just excess length of stay. Surgical safety checklists are tools to standardize safety assessment and improve teamwork and communication in surgical care, and also generally include specific steps to reduce SSI risk (for example, ensuring that preoperative antimicrobial prophylaxis has been administered at the appropriate time). Increasing numbers of patients also undergo surgery at ambulatory surgery centers (facilities specifically designed for certain types of surgery after which the patient can be discharged home directly). Therefore, the knock-on impact of focusing on hand hygiene can lead to an overall improvement in patient safety across an entire organization. Allegranzi B, Zayed B, Bischoff P, et al. The parameter estimate for being a case was 1.30 for log-transformed costs in the unadjusted model and 1.20 for log-transformed costs in the adjusted model when chronic disease score was included. Impact of a Surgical Site Infection Surgical site infections result from the interaction of microorgan - isms (living things too small to be seen by the naked eye) in the health - care environment, a compromised host (a patient who is vulnerable to infection), and the chain of transmission. This finding suggests that, even after preexisting conditions are adjusted for, SSIs recognized after hospital discharge are significantly associated with higher total costs. [].Although there are global variations … All case-patients and matched pairs were mailed a 49-item questionnaire, an explanatory letter, and a consent form. Although patients were not asked about their use of resources in the 4 weeks before surgery until weeks after the surgery took place, we have found that for scaled scores, such as the SF-12 used in this study, patients consistently reported similar results during the hospital stay and 3 months later (27). Patients with an SSI recognized after discharge also used significantly more resources outside of the ambulatory-care centers. The AHRQ Safety Program for Surgery used a multicomponent intervention designed to improve safety culture in order to promote consistent use of the World Health Organization surgical safety checklist, and additionally to promote SSI prevention. In addition, each patient provided a signed consent form before completing the questionnaire and being enrolled in the study. Surgical site infection (SSI) continues to represent a significant portion of healthcare-associated infections. below. The intervention was associated with a significant reduction in SSI rates at participating hospitals, accompanied by improvement in perceived safety culture. Strategy, Plain In addition, Harvard Pilgrim Health Care maintained an automated ambulatory medical record system that captured all ambulatory encounters and orders at its health centers. The magnitude of this drop, compared to results for controls, was similar to one reported for those who have experienced their first myocardial infarction (26). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. One hundred seventy-three (65%) of 267 questionnaires were returned. The AHRQ Safety Program for Surgery used the CUSP model and implementation science approaches to improve adherence to evidence-based SSI prevention practices in 197 hospitals. SSIs occur in 2% to 4% of all patients undergoing inpatient surgical procedures. Policies, HHS Digital An investigator reviewed those records judged to indicate a postdischarge SSI by initial screening, using the National Nosocomial Infections Surveillance criteria during the 30-day postoperative period to confirm infection (14). Nosocomial surgical infections: incidence and cost. In our study, 23% of the readmissions occurred at settings other than the index hospital. Much has been published in recent years about the impact of diabetes on increased rates of surgical site infection (SSI) and the potentially related impact of hyperglycemia on SSI. Financial Impact of Surgical Site Infections (SSIs) – Eloquest Healthcare, Inc. Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge. This database included the associated discharge date for index surgery, from which we calculated the 8 weeks’ postoperative time window for our analysis and from which we counted the resource utilization across all databases. Patients required significantly more outpatient visits, emergency room visits, radiology services, readmissions, and home health aide services than did controls. These rehospitalizations led to $7,925 charges per person with an SSI compared with charges of $2,079 for those without an SSI (p<0.001). Accurate measurement can be a challenge in patient safety, but prevention of SSIs (and HAIs in general) has benefited from the development of standard metrics that allow for tracking of infection rates over time and comparison of infection rates between facilities. A greater proportion of case-patients (62%) than controls (47%) required home health services (p=0.009). Surgeries were identified in 2-week cycles, and a total of 38 cycles were completed. Patients with an SSI recognized after discharge generated higher standard wholesale costs for antibiotics than did controls without an SSI. More case-patients (31%) had at least one visit to an emergency room compared to controls (9%), p<0.001, and they generated significantly more emergency room charges ($333 vs. $114, p<0.001). Surgical site infections are associated with increased hospital length of stay and increased episode cost after surgery. A chronic disease score with empirically derived weights. Surgical site infections (SSI) are serious operative complications that occur in approximately 2% of surgical procedures, although rates vary widely according to type of procedure.2 SSI can have a devastating impact on the patient's course of treatment and is associated with increased treatment intensity, prolonged length of stay (LOS), and higher costs. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Key elements of organizational interventions to prevent SSIs (and HAIs in general) include improving safety culture, the use of robust data tracking and feedback mechanisms, and utilizing checklists or evidence-based bundles. Those who completed the questionnaire (responders) were slightly older than those that did not respond (58.2 years vs. 54.6 years, p=0.05). SSI recognized after discharge was confirmed in 89 (1.9%) of 4,571 procedures. With respect to direct medical costs, SSIs diagnosed after hospital discharge incurred significantly more attributable use of resources than matched controls in each of the following categories: outpatient visits, inpatient care, pharmacy, radiology, home health aide care, and durable medical equipment. The mean chronic disease score was significantly higher among case-patients (3,058) than controls (2,148) (p=0.005), as expected on the basis of the higher prevalence of selected chronic diseases in those at risk for an SSI. Advances in perioperative quality and safety. Almost all assessed utilization outcomes, including all charges, were non-normally distributed so both medians with interquartile range and means with standard deviation are reported. There was a trend towards more case-patients having diabetes than controls (24% vs. 12% p=0.06). Given the high costs and adverse patient outcomes associated with SSIs, quantifying the clinical and economic impact of SSIs recognized after discharge from the hospital is important. The chronic disease score, as used here, is a method for controlling for preexisting conditions on the basis of patient age, gender, and recent history of drug dispensing. National Surgical Quality Improvement Program. However, as with many other quality problems, implementing the recommended methods as standard practice and sustaining the use of preventive interventions has been challenging. Surgical site infections (SSIs), the second most common cause of nosocomial infection after urinary tract infections, cause approximately 17% of all hospital-acquired infections (1) and lead to increased costs and worse patient outcomes in hospital inpatients (2). This health maintenance organization maintains an automated administrative claims system that houses all charges from vendors, including hospitals, and outside the ambulatory-care centers. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. According to data from AHRQ, more than 10 million patients undergo surgical procedures as inpatients each year, accounting for over one-fourth of all hospital stays. Therefore, costs were $3,382 or 2.9 times greater in patients with SSI recognized after discharge. Denominator For With the current trends favoring a shortened postoperative hospital stay, outpatient surgery, and same-day surgery, more SSIs are occurring after discharge from the hospital and, therefore, beyond the reach of most hospital infection control surveillance programs (8). There was an unexpected error. The number of laboratory tests ordered did not differ between cases and controls. To measure the impact of orthopedic surgical-site infections (SSIs) on quality of life, length of hospitalization, and cost. Comment submitted successfully, thank you for your feedback. [Epub ahead of print] The impact of surgical site infections on hospital contribution margin-a European prospective observational cohort study. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Surgical site infections (SSIs), the second most common cause of nosocomial infection after urinary tract infections, cause approximately 17% of all hospital-acquired infections (1) and lead to increased costs and worse patient outcomes in hospital inpatients (2). Since combined total costs and charges (ambulatory, pharmacy, and nonambulatory) of the entire cohort of 267 patients were log-normally distributed, the total cost variable was analyzed by using a log-transformation of total costs in a matched linear regression model. Across all settings, patients can acquire bloodstream infections, surgical site infections, urinary tract infections, chest/respiratory infections or gastrointestinal infections. We conclude that SSIs diagnosed after hospital discharge were associated with significant impairment of physical and mental health. The subsets of these costs that occurred in those 216 patients never readmitted to any hospital (including the index hospital) were, on average, $928 in case-patients and $621 in controls (p<0.001). The qualitative experience of having a surgical site infection (SSI) is often overlooked. To sign up for updates or to access your subscriber preferences, please enter your email address Patients who had an SSI that occurred during the index hospitalization were excluded. Therefore, 24% of costs attributable to the SSI recognized after discharge would typically occur beyond the cost accounting systems of most index hospitals in which the initial surgical procedure was performed. An estimated 47% to 84% of SSIs occur after discharge; most of these are managed entirely in the outpatient setting (8,10). In addition, pharmacy records were screened for antibiotic dispensing, and claims were screened for hospital readmissions or emergency room visits pertaining to an SSI. We recognize that we were unable to assess all societal costs of SSI, such as individual patient transportation costs. Infect Control Hosp Epidemiol. Surgical wound infections documented after hospital discharge. Rockville, MD 20857 Patients with an SSI were more likely to be readmitted to the hospital (34%) than those without an SSI (12%), p<0.001. Additionally, in this particular cohort of patients, 23% of all re-admissions and 18% of all emergency room visits occurred at institutions other than the index hospital; such visits and admissions would not have been captured by standard inpatient infection control surveillance. The addition of duration of index surgery into the model did not significantly confound the attributable impact that SSI had on higher total costs (Table 5). Harvard Pilgrim Health Care also maintains a database that captures all pharmacy prescriptions dispensed in the outpatient setting (17). Cases and matched controls were compared by using the Wilcoxon signed-ranks test for continuous outcomes with non-normal distributions, continuous linear regression by forcing the matching variable into the model for normally distributed variables, or the Cochran-Mantel-Haenszel for matched binary variables. Risk of surgical site infections following hip and knee arthroplasty: results of the ISChIA-GISIO study. 2002;23(4):183-189. doi:10.1086/502033. With the aging of the population and the expected increase in surgical procedures in the elderly, strategies for prevention and … ( SAS Institute, Inc., Cary, NC ) are widely used for both quality and. 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