ePrints

Assessment of risk and economic burden of surgical site infection (SSI) posthysterectomy using a U.S. longitudinal database

Lookup NU author(s): Professor David Leaper

Downloads

Full text for this publication is not currently held within this repository. Alternative links are provided below where available.

Abstract

© 2021 Elsevier Inc.Background: Surgical site infection posthysterectomy has significant impact on patient morbidity, mortality, and health care costs. This study evaluates incidence, risk factors, and total payer costs of surgical site infection after hysterectomy in commercial, Medicare, and Medicaid populations using a nationwide claims database. Methods: IBM MarketScan databases identified women having hysterectomy between 2014 and 2018. Deep-incisional/organ space (DI/OS) and superficial infections were identified over 6 months postoperatively with risk factors and direct infection-associated payments by insurance type over a 24-month postoperative period. Results: Analysis identified 141,869 women; 7.8% Medicaid, 5.8% Medicare, and 3.9% commercially insured women developed deep-incisional/organ space surgical site infection, whereas 3.9% Medicaid, 3.2% Medicare, and 2.1% commercially insured women developed superficial infection within 6 months of index procedure. Deep-incisional/organ space risk factors were open approach (hazard ratio, 1.6; 95% confidence interval, 1.5–1.8) and payer type (Medicaid versus commercial [hazard ratio, 1.4; 95% confidence interval, 1.3–1.5]); superficial risk factors were payer type (Medicaid versus commercial [hazard ratio, 1.4; 95% confidence interval, 1.3–1.6]) and solid tumor without metastasis (hazard ratio, 1.4; 95% confidence interval, 1.3–1.6). Highest payments occurred with Medicare ($44,436, 95% confidence interval: $33,967–$56,422) followed by commercial ($27,140, 95% confidence interval: $25,990–$28,317) and Medicaid patients ($17,265, 95% confidence interval: $15,247–$19,426) for deep-incisional/organ space infection at 24-month posthysterectomy. Conclusions: Real-world cost of managing superficial, deep-incisional/organ space infection after hysterectomy was significantly higher than previously reported. Surgical approach, payer type, and comorbid risk factors contributed to increased risk of infection and economic burden. Medicaid patients experienced the highest risk of infection, followed by Medicare patients. The study suggests adoption of a robust evidence-based surgical care bundle to mitigate risk of surgical site infection and economic burden is warranted.

Publication metadata

Author(s): Edmiston CE, Bond-Smith G, Spencer M, Chitnis AS, Holy CE, Po-Han Chen B, Leaper DJ

Publication type: Article

Publication status: Published

Journal: Surgery

Year: 2022

Volume: 171

Issue: 5

Pages: 1320-1330

Print publication date: 01/05/2022

Online publication date: 29/12/2021

Acceptance date: 29/11/2021

ISSN (print): 0039-6060

ISSN (electronic): 1532-7361

Publisher: Elsevier Inc.

URL: https://doi.org/10.1016/j.surg.2021.11.034

DOI: 10.1016/j.surg.2021.11.034

Altmetrics

Share