Deep Surgical Site Infections after Open Radical Cystectomy and Urinary Diversion Significantly Increase Hospitalisation Time and Total Treatment Costs.
BACKGROUND
Deep surgical site infections (DSSI) usually require secondary treatments. The aim of this study was to compare the total length of hospitalisation (LOH), intensive care unit (ICU) duration, and total treatment costs in patients with DSSI versus without DSSI after open radical cystectomy (ORC) and urinary diversion.


METHODS
Prospective case-control study in a tertiary care hospital in patients after ORC with urinary diversion during April 2008 to July 2012. DSSI was defined based on Centers for Disease Control and Prevention criteria. Matched-pair analysis for patients with versus without DSSI was done in 1:2 ratios. Patients with superficial surgical site infections (SSI) were excluded from analysis.


RESULTS
In total, 189 operations were performed. Thirty-eight patients (20.1%) developed SSI of which 28 patients (14.8%) had DSSI. Out of 28 patients, 27 (96.4%) were with DSSI and required surgical re-intervention. Due to insufficient matching criteria, 11 patients with DSSI were excluded from analyses. Consequently, 17 patients with DSSI were matched with 34 patients without DSSI. Significant differences were seen for median overall LOH (30 vs. 18 days, p < 0.001), median ICU duration (p = 0.024), and median overall treatment costs (€17,030 vs. €11,402, p = 0.011).


CONCLUSIONS
DSSI significantly increases LOH (67%) and treatment costs (49%), adding up to a financial loss for the hospital of approximately €5,500 in patients with DSSI.
Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany.
Mathias
M
Wolters
Matthias
M
Oelke
Bettina
B
Lutze
Markus
M
Weingart
Markus A
MA
Kuczyk
Iris F
IF
Chaberny
Karolin
K
Graf
D016022:Case-Control Studies; D003422:Critical Care / Q000191:economics; D015653:Cystectomy / Q000009:adverse effects* / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology*; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D001743:Urinary Bladder; D001749:Urinary Bladder Neoplasms / Q000191:economics* / Q000601:surgery; D014547:Urinary Diversion