title: Hospital costs associated with surgical site infections in general and vascular surgery patients.
abstract: BACKGROUND
  Although much has been written about excess cost and duration of stay (DOS) associated with surgical site infections (SSIs) after cardiothoracic surgery, less has been reported after vascular and general surgery. We used data from the National Surgical Quality Improvement Program (NSQIP) to estimate the total cost and DOS associated with SSIs in patients undergoing general and vascular surgery.
  
  
  METHODS
  Using standard NSQIP practices, data were collected on patients undergoing general and vascular surgery at a single academic center between 2007 and 2009 and were merged with fully loaded operating costs obtained from the hospital accounting database. Logistic regression was used to determine which patient and preoperative variables influenced the occurrence of SSIs. After adjusting for patient characteristics, costs and DOS were fit to linear regression models to determine the effect of SSIs.
  
  
  RESULTS
  Of the 2,250 general and vascular surgery patients sampled, SSIs were observed in 186 inpatients. Predisposing factors of SSIs were male sex, insulin-dependent diabetes, steroid use, wound classification, and operative time (P < .05). After adjusting for those characteristics, the total excess cost and DOS attributable to SSIs were $10,497 (P < .0001) and 4.3 days (P < .0001), respectively.
  
  
  CONCLUSIONS
  SSIs complicating general and vascular surgical procedures share many risk factors with SSIs after cardiothoracic surgery. Although the excess costs and DOS associated with SSIs after general and vascular surgery are somewhat less, they still represent substantial financial and opportunity costs to hospitals and suggest, along with the implications for patient care, a continuing need for cost-effective quality improvement and programs of infection prevention.
authors.affiliation: Division of Outcomes Research and Quality, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033-0850, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Boltz
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Julian
authors.forename: Gail
authors.initials: G
authors.lastname: Ortenzi
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillon
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000328:Adult; D003428:Cross Infection / Q000191:economics / Q000401:mortality; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000191:economics* / Q000401:mortality*; D014656:Vascular Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data