A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections.
OBJECTIVE
We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources.


METHODS
The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes.


METHODS
A large tertiary care medical center and an affiliated Veterans Affairs Medical Center.


METHODS
A total of 3,864 surgical patients.


RESULTS
The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population.


CONCLUSIONS
Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.
Herwaldt
Loreen A
LA
Department of Internal Medicine, University of Iowa College of Public Health, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. loreen-herwaldt@uiowa.edu
Cullen
Joseph J
JJ
Scholz
David
D
French
Pamela
P
Zimmerman
M Bridget
MB
Pfaller
Michael A
MA
Wenzel
Richard P
RP
Perl
Trish M
TM
D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000191:economics*; D003695:Delivery of Health Care; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality*; D013530:Surgical Wound Infection / Q000191:economics* / Q000382:microbiology / Q000401:mortality; D016896:Treatment Outcome