Impact of surgical site infections after open and laparoscopic colon and rectal surgeries on postoperative resource consumption.
OBJECTIVE
To estimate the impact of surgical site infection (SSI) on postoperative resource consumption for colon and rectal open and laparoscopic surgeries after accounting for infection depth and patient characteristics, and to compare these estimates among institutions.


METHODS
We collected administrative and SSI-related data from eight Japanese hospitals, and used generalized linear models to estimate excess postoperative length of stay (LOS) and charges attributable to SSI. Covariates included wound class, American Society of Anesthesiologists (ASA) score, operation time, emergency, colostomy, trauma, implant, and comorbidities.


RESULTS
We examined 1,108 colon surgery (CS) and 477 rectal surgery (RS) patients. For open surgery, the postoperative LOS in non-SSI patients was 13.5 (CS) and 15.9 days (RS). Compared with non-SSI patients, the postoperative LOS increased by 4.5 (CS) and 2.8 days (RS) for superficial SSI, 6.8 (CS) and 8.5 days (RS) for deep SSI, and 7.8 and 9.5 days for space/organ SSI. For laparoscopic surgery, the postoperative LOS was 9.8 (CS) and 14.6 days (RS). SSI was significantly associated with increased postoperative LOS for superficial SSI [by 4.8 (CS) and 3.6 days (RS)], deep SSI [by 10.3 (CS) and 23.9 days (RS)], and space/organ SSI [by 8.9 days (RS)]. The postoperative LOS among hospitals was 3.8-10.4 days (CS) and 1.3-12.2 days (RS). Postoperative SSI-attributable charges ranged from $386 to $2,873, depending on organ, procedure, and infection depth.


CONCLUSIONS
This study quantified the impact of SSIs on resource consumption and confirmed significant cost variations among hospitals. These variations could not be explained by patient characteristics or infection type.
Institute for Health Economics and Policy, 1-5-11 Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan. haruhisa.fukuda@ihep.jp
H
H
Fukuda
K
K
Morikane
M
M
Kuroki
S
S
Kawai
K
K
Hayashi
Y
Y
Ieiri
H
H
Matsukawa
K
K
Okada
F
F
Sakamoto
T
T
Shinzato
S
S
Taniguchi
D003106:Colon / Q000601:surgery; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay / Q000191:economics*; D016014:Linear Models; D008297:Male; D011184:Postoperative Period; D012007:Rectum / Q000601:surgery; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000191:economics* / Q000209:etiology