Clinical and economic consequences of post-operative infections following major elective surgery in U.S. hospitals.
BACKGROUND
The incidence and consequences of post-operative infections in patients undergoing major elective surgery is not well understood.


METHODS
Using a large U.S. healthcare claims database, we identified all patients who underwent major elective surgery between January 1, 2007, and December 31, 2009. For each such patient, date of the first-noted surgery during this period was designated as the index date. Patients who developed infections within 30 d of their index date were matched to those who did not using propensity score matching. We compared hospital readmissions, mortality, and total healthcare cost during the 30-d period following index date between patients who developed post-operative infections versus those who did not.


RESULTS
A total of 327,618 patients met all selection criteria. At 30 d following major elective surgery, 10.9% of patients had evidence of post-operative infections, 39% of which occurred during the index admission. In propensity-matched analyses, patients with post-operative infections were about five times as likely to be readmitted to hospital (11.3% vs. 2.1%) and more than twice as likely to die (0.8% vs. 0.3%) in the 30-d period following surgery; their average total healthcare cost was $8,417 higher ($29,229 vs. $20,812) (all comparisons, p<0.01).


CONCLUSIONS
Approximately one in 10 patients undergoing major elective surgery develop post-operative infections by day 30. Post-operative infections are associated with significantly worse clinical outcomes and higher total healthcare cost.
1 Policy Analysis Inc. , Brookline, Massachusetts.
Ariel
A
Berger
John
J
Edelsberg
Holly
H
Yu
Gerry
G
Oster
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D013530:Surgical Wound Infection / Q000191:economics* / Q000453:epidemiology*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult