title: Financial impact of surgical site infection after kidney transplantation: implications for quality improvement initiative design.
abstract: BACKGROUND
  Surgical site infection (SSI) after kidney transplantation has been associated with worse graft and patient survival. Although there are clinical incentives to reduce the incidence of SSI, it is unknown whether these are aligned with financial incentives for payers and providers. We use post-kidney transplant surgical site infection (SSI) to quantify the financial implications of surgical complications. The goal of this study was to quantify the financial costs of SSI after kidney transplantation and to determine the party bearing the brunt of these costs.
  
  
  METHODS
  This was a retrospective cohort study of all adult, first-time kidney-only transplant recipients at the University of Michigan Health System from September 2003 to April 2008 (n = 869). The primary exposure variable was SSI. SSI was defined as skin dehiscence, fascial dehiscence, or bowel evisceration. Primary outcomes measures were hospital revenue (payer costs), hospital inpatient costs, and hospital margin. We used simple univariate (t-test) analysis and multivariate (generalized linear regression) models to control for donor, recipient, and insurer characteristics.
  
  
  RESULTS
  Eighteen percent of patients had documented SSIs. In cases with an SSI hospital revenue increased by $20,176, hospital margin decreased by $4,278, and hospital costs increased by $24,454. When adjusted for donor and recipient characteristics, SSI was independently associated with an $11,132 increase in hospital revenue.
  
  
  CONCLUSIONS
  Although SSIs have negative financial effects on both hospitals and payers, the impact is greater on payers. Payers have the primary financial incentive to reduce SSI, and broad-based, quality improvement initiatives can be prudent investments for payers. Quantification of the costs associated with SSI can be used to define financial parameters for such initiatives that might prove beneficial to multiple stakeholders.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Ho
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Lynch
authors.forename: David N
authors.initials: DN
authors.lastname: Ranney
authors.forename: Avedis
authors.initials: A
authors.lastname: Magar
authors.forename: Jim
authors.initials: J
authors.lastname: Kubus
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006084:Graft Rejection / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics*; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics*