Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center.
OBJECTIVE
To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital.


METHODS
Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections.


METHODS
A university referral center in Canada.


METHODS
Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991.


METHODS
During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs.


RESULTS
We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%.


CONCLUSIONS
Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.
Zoutman
D
D
Department of Pathology, Kingston General Hospital and Queen's University, Ontario, Canada. zoutman@cliff.path.queensu.ca
McDonald
S
S
Vethanayagan
D
D
D006745:Hospital Bed Capacity, 300 to 499; D017721:Hospital Costs; D006769:Hospitals, General / Q000191:economics; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D017053:Infection Control / Q000592:standards; D007902:Length of Stay; D009864:Ontario; D013530:Surgical Wound Infection / Q000191:economics* / Q000517:prevention & control