title: Serious postoperative infections following resection of common solid tumors: outcomes, costs, and impact of hospital surgical volume.
abstract: OBJECTIVE
  Unlike infections related to chemotherapy-induced neutropenia, postoperative infections occurring in patients with solid malignancy remain largely understudied. Our aim is to evaluate the outcomes and the volume-outcomes relationship associated with postoperative infections following resection of common solid tumors.
  
  
  METHODS
  We used Texas Discharge Data to study patients undergoing resection of cancer of the lung, esophagus, stomach, pancreas, colon, or rectum from 01/2002 to 11/2006. From their billing records, we identified ICD-9 codes indicating a diagnosis of serious postoperative infection (SPI), i.e., bacteremia/sepsis, pneumonia, and wound infection, occurring during surgical admission or leading to readmission within 30 days of surgery. Using regression-based techniques, we estimated the impact of SPI on mortality, resource utilization, and costs, as well as the relationship between hospital volume and SPI, after adjusting for confounders and data clustering.
  
  
  RESULTS
  SPI occurred following 9.4 % of the 37,582 eligible tumor resections and was independently associated with nearly 12-fold increased odds of in-hospital mortality [95 % confidence interval (95 % CI), 7.2-19.5, P < 0.001]. Patients with SPI required six additional hospital days (95 % CI, 5.9-6.2) at an incremental cost of $16,991 (95 % CI, $16,495-$17,497). Patients who underwent resection at high-volume hospitals had a 16 % decreased odds of developing SPI than those at low-volume hospitals (P = 0.03).
  
  
  CONCLUSIONS
  Due to the substantial burden associated with SPI following common solid tumor resections, hospitals must identify more effective prophylactic measures to avert these potentially preventable infections. Additional volume-outcomes research is needed to identify infection prevention processes that can be transferred from high- to lower-volume providers.
authors.affiliation: Center for Clinical Research & Evidence-Based Medicine, The University of Texas Medical School at Houston, 6431 Fannin St., MSB 2.101, Houston, TX, 77030, USA, Elenir.B.Caramel@uth.tmc.edu.
authors.forename: Elenir B C
authors.initials: EB
authors.lastname: Avritscher
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Cooksley
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Rolston
authors.forename: J Michael
authors.initials: JM
authors.lastname: Swint
authors.forename: George L
authors.initials: GL
authors.lastname: Delclos
authors.forename: Luisa
authors.initials: L
authors.lastname: Franzini
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Paul F
authors.initials: PF
authors.lastname: Mansfield
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
mesh_terms: D000328:Adult; D000368:Aged; D003631:Day Care, Medical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000191:economics / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000382:microbiology* / Q000401:mortality; D012044:Regression Analysis; D018805:Sepsis / Q000191:economics / Q000209:etiology* / Q000401:mortality; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D013781:Texas / Q000453:epidemiology