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Impact of surgical site infections after open and laparoscopic colon and rectal surgeries on postoperative resource consumption

  • Clinical and Epidemiological Study
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Abstract

Purpose

To estimate the impact of surgical site infection (SSI) on postoperative resource consumption for colon and rectal open and laparoscopic surgeries after accounting for infection depth and patient characteristics, and to compare these estimates among institutions.

Methods

We collected administrative and SSI-related data from eight Japanese hospitals, and used generalized linear models to estimate excess postoperative length of stay (LOS) and charges attributable to SSI. Covariates included wound class, American Society of Anesthesiologists (ASA) score, operation time, emergency, colostomy, trauma, implant, and comorbidities.

Results

We examined 1,108 colon surgery (CS) and 477 rectal surgery (RS) patients. For open surgery, the postoperative LOS in non-SSI patients was 13.5 (CS) and 15.9 days (RS). Compared with non-SSI patients, the postoperative LOS increased by 4.5 (CS) and 2.8 days (RS) for superficial SSI, 6.8 (CS) and 8.5 days (RS) for deep SSI, and 7.8 and 9.5 days for space/organ SSI. For laparoscopic surgery, the postoperative LOS was 9.8 (CS) and 14.6 days (RS). SSI was significantly associated with increased postoperative LOS for superficial SSI [by 4.8 (CS) and 3.6 days (RS)], deep SSI [by 10.3 (CS) and 23.9 days (RS)], and space/organ SSI [by 8.9 days (RS)]. The postoperative LOS among hospitals was 3.8–10.4 days (CS) and 1.3–12.2 days (RS). Postoperative SSI-attributable charges ranged from $386 to $2,873, depending on organ, procedure, and infection depth.

Conclusion

This study quantified the impact of SSIs on resource consumption and confirmed significant cost variations among hospitals. These variations could not be explained by patient characteristics or infection type.

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Acknowledgments

We thank Kieko Nakamura (Kyorin University Hospital), Yoko Higashi (Department of Surgery, Japanese Red Cross Kumamoto Hospital), Toshiaki Tasaki (Saiseikai Kumamoto Hospital), Emi Ito (Yokohama Minami Kyosai Hospital), Rumi Tsuchiya (Saku Central Hospital), Chieko Iha (Nakagami General Hospital), and Seiko Okuda (Sasebo Chuo Hospital) for organizing and providing the data needed to complete this project. This research was supported, in part, by a Grant-in-Aid for Young Scientists (B) from the Japan Society for the Promotion of Science (JSPS).

Conflict of interest

The authors report no conflicts of interest.

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Authors and Affiliations

  1. Institute for Health Economics and Policy, 1-5-11 Nishi-Shinbashi, Minato-ku, Tokyo, 105-0003, Japan

    H. Fukuda

  2. Division of Clinical Laboratory & Division of Infection Control, Yamagata University Hospital, 2-2-2 Iida-nishi, Yamagata, 990-9585, Japan

    K. Morikane

  3. The Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo, 190-8562, Japan

    M. Kuroki

  4. Department of Infectious Disease, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    S. Kawai

  5. Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Kumamoto, 861-8520, Japan

    K. Hayashi

  6. Department of Total Quality Management, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan

    Y. Ieiri

  7. Department of Surgery, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan

    H. Matsukawa

  8. Emergency and Critical Care Medical Center, Saku Central Hospital, 197 Usuda, Saku, Nagano, 384-0301, Japan

    K. Okada

  9. Division of Safety Management, St. Luke’s International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    F. Sakamoto

  10. Department of Infectious Diseases and Internal Medicine, Nakagami General Hospital, 6-25-5 Chibana, Okinawa, 904-2195, Japan

    T. Shinzato

  11. Department of Cardiovascular Surgery, Sasebo Chuo Hospital, 15, Yamato-cho, Sasebo, Nagasaki, 857-1195, Japan

    S. Taniguchi

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  1. H. Fukuda
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  2. K. Morikane
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  3. M. Kuroki
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  4. S. Kawai
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  5. K. Hayashi
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  6. Y. Ieiri
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  7. H. Matsukawa
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  8. K. Okada
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  9. F. Sakamoto
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  10. T. Shinzato
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  11. S. Taniguchi
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Corresponding author

Correspondence to H. Fukuda.

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Fukuda, H., Morikane, K., Kuroki, M. et al. Impact of surgical site infections after open and laparoscopic colon and rectal surgeries on postoperative resource consumption. Infection 40, 649–659 (2012). https://doi.org/10.1007/s15010-012-0317-7

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  • DOI: https://doi.org/10.1007/s15010-012-0317-7

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