title: Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital.
abstract: BACKGROUND
  Although surgical site infections (SSIs) are known to be associated with increased length of stay (LOS) and additional cost, their impact on the profitability of surgical procedures is unknown.
  
  
  OBJECTIVE
  To determine the clinical and economic burden of SSI over a two-year period and to predict the financial consequences of their elimination.
  
  
  METHODS
  SSI surveillance and Patient Level Information and Costing System (PLICS) datasets for patients who underwent major surgical procedures at Plymouth Hospitals NHS Trust between April 2010 and March 2012 were consolidated. The main outcome measures were the attributable postoperative length of stay (LOS), cost, and impact on the margin differential (profitability) of SSI. A secondary outcome was the predicted financial consequence of eliminating all SSIs.
  
  
  RESULTS
  The median additional LOS attributable to SSI was 10 days [95% confidence interval (CI): 7-13 days] and a total of 4694 bed-days were lost over the two-year period. The median additional cost attributable to SSI was £5,239 (95% CI: 4,622-6,719) and the aggregate extra cost over the study period was £2,491,424. After calculating the opportunity cost of eliminating all SSIs that had occurred in the two-year period, the combined overall predicted financial benefit of doing so would have been only £694,007. For seven surgical categories, the hospital would have been financially worse off if it had successfully eliminated all SSIs.
  
  
  CONCLUSIONS
  SSI causes significant clinical and economic burden. Nevertheless the current system of reimbursement provided a financial disincentive to their reduction.
authors.affiliation: Departments of Microbiology and Infection Prevention and Control, Derriford Hospital, Plymouth, UK. Electronic address: peter.jenks@nhs.net.
authors.forename: P J
authors.initials: PJ
authors.lastname: Jenks
authors.affiliation: ICNet International, Stroud, UK.
authors.forename: M
authors.initials: M
authors.lastname: Laurent
authors.affiliation: Department of Finance, Derriford Hospital, Plymouth, UK.
authors.forename: S
authors.initials: S
authors.lastname: McQuarry
authors.affiliation: ICNet International, Stroud, UK.
authors.forename: R
authors.initials: R
authors.lastname: Watkins
mesh_terms: D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control; D004739:England / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D007902:Length of Stay; D015995:Prevalence; D013530:Surgical Wound Infection / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control
keywords: Attributable cost; Healthcare-associated infection; Length of stay; Margin (profitability); Opportunity cost; Surgical site infection