Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals.
OBJECTIVE
Surgical site infections (SSIs) are potentially preventable complications that are associated with excess morbidity and mortality.


OBJECTIVE
To determine the excess costs associated with total, deep, and superficial SSIs among all operations and for high-volume surgical specialties.


METHODS
Surgical patients from 129 Veterans Affairs (VA) hospitals were included. The Veterans Health Administration Decision Support System and VA Surgical Quality Improvement Program databases were used to assess costs associated with SSIs among VA patients who underwent surgery in fiscal year 2010.


METHODS
Linear mixed-effects models were used to evaluate incremental costs associated with SSIs, controlling for patient risk factors, surgical risk factors, and hospital-level variation in costs. Costs of the index hospitalization and subsequent 30-day readmissions were included. Additional analysis determined potential cost savings of quality improvement programs to reduce SSI rates at hospitals with the highest risk-adjusted SSI rates.


RESULTS
Among 54,233 VA patients who underwent surgery, 1756 (3.2%) experienced an SSI. Overall, 0.8% of the cohort had a deep SSI, and 2.4% had a superficial SSI. The mean unadjusted costs were $31,580 and $52,620 for patients without and with an SSI, respectively. In the risk-adjusted analyses, the relative costs were 1.43 times greater for patients with an SSI than for patients without an SSI (95% CI, 1.34-1.52; difference, $11,876). Deep SSIs were associated with 1.93 times greater costs (95% CI, 1.71-2.18; difference, $25,721), and superficial SSIs were associated with 1.25 times greater costs (95% CI, 1.17-1.35; difference, $7003). Among the highest-volume specialties, the greatest mean cost attributable to SSIs was $23,755 among patients undergoing neurosurgery, followed by patients undergoing orthopedic surgery, general surgery, peripheral vascular surgery, and urologic surgery. If hospitals in the highest 10th percentile (ie, the worst hospitals) reduced their SSI rates to the rates of the hospitals in the 50th percentile, the Veterans Health Administration would save approximately $6.7 million per year.


CONCLUSIONS
Surgical site infections are associated with significant excess costs. Among analyzed surgery types, deep SSIs and SSIs among neurosurgery patients are associated with the highest risk-adjusted costs. Large potential savings per year may be achieved by decreasing SSI rates.
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa2Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City.
Marin L
ML
Schweizer
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.
Joseph J
JJ
Cullen
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa2Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City.
Eli N
EN
Perencevich
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa2Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City.
Mary S
MS
Vaughan Sarrazin
D017046:Cost Savings; D003365:Costs and Cost Analysis; D005260:Female; D006787:Hospitals, Veterans / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000191:economics*; D014481:United States; D014728:Veterans