What is the value of preventing postoperative infections?
The importance of postoperative infections depends on the frequency with which infection occurs as well as on the additional cost per patient with infection. For example, in our hospital the additional cost per patient with infection after hernia repair was $600, compared with $2,106 per patient with infection after colonic surgery. However, the total excess cost per year was similar for hernia surgery ($44,800) and colon surgery ($48,440). The reason is that hernia surgery is much more common than colon surgery. It is a general principle of clinical audit that the importance of problems should be defined by their frequency as well as their individual severity. A third important consideration is the likelihood that the problem can be corrected. Undue attention has been given to the health resource costs of postoperative infection at the expense of information about the intangible costs to the patient (these are nonfinancial costs such as pain and disability). Health resource costs are very dependent on medical practice variation, and comparative studies between countries reveal marked differences in the way that apparently similar infections are managed. Moreover, comprehensive audit of infection-control management often reveals wasteful practice, e.g, antibiotic treatment of patients who do not in fact have infection. Audit of postoperative infection should focus on eliminating wasteful practice (e.g., prophylactic antibiotics continuing > 24 hrs after surgery) as well as on reducing postoperative infection rates.
Davey
P G
PG
Department of Clinical Pharmacology, Pharmacoeconomics Research Centre, Ninewells Hospital and Medical School, Dundee, Scotland.
Nathwani
D
D
D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D006801:Humans; D017053:Infection Control / Q000191:economics*; D008485:Medical Audit / Q000191:economics / Q000379:methods*; D013503:Surgery Department, Hospital / Q000191:economics*; D013530:Surgical Wound Infection / Q000191:economics / Q000517:prevention & control*