Skip to main content Accessibility help

Economic Burden of Surgical Site Infections at a European University Hospital

  • Walter P. Weber (a1), Marcel Zwahlen (a2), Stefan Reck (a1), Chantal Feder-Mengus (a1), Heidi Misteli (a1), Rachel Rosenthal (a1), Daniel Brandenberger (a1), Daniel Oertli (a1), Andreas F. Widmer (a3) and Walter R. Marti (a1)...



To quantify the economic burden of in-hospital surgical site infections (SSIs) at a European university hospital.


Matched case-control study nested in a prospective observational cohort study.


Basel University Hospital in Switzerland, where an average of 28,000 surgical procedures are performed per year.


All in-hospital occurrences of SSI associated with surgeries performed between January 1, 2000, and December 31, 2001, by the visceral, vascular, and traumatology divisions at Basel University Hospital were prospectively recorded. Each case patient was matched to a control patient by age, procedure code, and National Nosocomial Infection Surveillance System risk index. The case-control pairs were analyzed for differences in cost of hospital care and in provision of specialized care.


A total of 6,283 procedures were performed:187 SSIs were detected in inpatients, 168 of whom were successfully matched with a control patient. For case patients, the mean additional hospital cost was SwF19,638 (95% confidence interval [CI], SwF8,492–SwF30,784); the mean additional postoperative length of hospital stay was 16.8 days (95% CI, 13–20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI, 5.1–9.6 days). Differences were primarily attributable to organ space SSIs (n = 76).


Ina European university hospital setting, SSIs are costly and constitute a heavy and potentially preventable burden on both patients and healthcare providers.


Corresponding author

Department of General Surgery, University Hospital of Basel, CH-4031 Basel, Switzerland (


Hide All
1.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250278.
2.Clements, AC, Tong, EN, Morton, AP, Whitby, M. Risk stratification for surgical site infections in Australia: evaluation of the US National Nosocomial Infection Surveillance risk index. J Hosp Infect 2007;66:148155.
3.Fiorio, M, Marvaso, A, Vigano, F, Marchetti, F. Incidence of surgical site infections in general surgery in Italy. Infection 2006;34:310314.
4.Kaye, KS, Schmit, K, Pieper, C, et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis 2005;191:10561062.
5.Neumayer, L, Hosokawa, P, Itani, K, El-Tamer, M, Henderson, WG, Khuri, SF. Multivariable predictors of postoperative surgical site infection after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg 2007;204:11781187.
6.Vuorisalo, S, Haukipuro, K, Pokela, R, Syrjala, H. Risk features for surgical-site infections in coronary artery bypass surgery. Infect Control Hosp Epidemiol 1998;19:240247.
7.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 1991;91:152S157S.
8.Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206215.
9.Brandt, C, Sohr, D, Behnke, M, Daschner, F, Ruden, H, Gastmeier, P. Reduction of surgical site infection rates associated with active surveillance. Infect Control Hosp Epidemiol 2006;27:13471351.
10.Finkelstein, R, Rabino, G, Mashiah, T, et al. Surgical site infection rates following cardiac surgery: the impact of a 6-year infection control program. Am J Infect Control 2005;33:450454.
11.Gastmeier, P, Geffers, C, Brandt, C, et al. Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect 2006;64:1622.
12.Geubbels, EL, Nagelkerke, NJ, Mintjes-De Groot, AJ, Vandenbroucke-Grauls, CM, Grobbee, DE, De Boer, AS. Reduced risk of surgical site infections through surveillance in a network. Int J Qual Health Care 2006;18:127133.
13.Molina-Cabrillana, J, Chirino, CA, Rodriguez-Alvarez, JP, et al. Effect of surveillance on surgical site infection rate in knee and hip arthroplasty [in Spanish]. Rev Clin Esp 2007;207:388393.
14.Rioux, C, Grandbastien, B, Astagneau, P. Impact of a six-year control programme on surgical site infections in France: results of the INCISO surveillance. J Hosp Infect 2007;66:217223.
15.Sykes, PK, Brodribb, RK, McLaws, ML, McGregor, A. When continuous surgical site infection surveillance is interrupted: the Royal Hobart Hospital experience. Am J Infect Control 2005;33:422427.
16.Vilar-Compte, D, Roldan-Marin, R, Robles-Vidal, C, Volkow, P. Surgical site infection (SSI) rates among patients who underwent mastectomy after the introduction of SSI prevention policies. Infect Control Hosp Epidemiol 2006;27:829834.
17.Yasunaga, H, Ide, H, Imamura, T, Ohe, K. Accuracy of economic studies on surgical site infection. J Hosp Infect 2007;65:102107.
18.Coello, R, Charlett, A, Wilson, J, Ward, V, Pearson, A, Borriello, P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect 2005;60:93103.
19.Coskun, D, Aytac, J, Aydinli, A, Bayer, A. Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey. J Hosp Infect 2005;60:176179.
20.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592598.
21.Hollenbeak, CS, Murphy, DM, Koenig, S, Woodward, RS, Dunagan, WC, Fraser, VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000;118:397402.
22.Jenney, AW, Harrington, GA, Russo, PL, Spelman, DW. Cost of surgical site infections following coronary artery bypass surgery. ANZ J Surg 2001;71:662664.
23.Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725730.
24.McGarry, SA, Engemann, JJ, Schmader, K, Sexton, DJ, Kaye, KS. Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost. Infect Control Hosp Epidemiol 2004;25:461467.
25.Ortona, L, Federico, G, Fantoni, M, Pallavicini, F, Ricci, F, Antinori, A. A study on the incidence of postoperative infections and surgical sepsis in a university hospital. Infect Control 1987;8:320324.
26.Poulsen, KB, Bremmelgaard, A, Sorensen, AI, Raahave, D, Petersen, JV. Estimated costs of postoperative wound infections. A case-control study of marginal hospital and social security costs. Epidemiol Infect 1994;113:283295.
27.Vegas, AA, Jodra, VM, Garcia, ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 1993;9:504510.
28.Whitehouse, JD, Friedman, ND, Kirkland, KB, Richardson, WJ, Sexton, DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002;23:183189.
29.Fry, DE. The economic costs of surgical site infection. Surg Infect (Larchmt) 2002;3(suppl 1):S37S43.
30.Berry, DA, Lindgren, BW. Statistics: Theory and Methods. 2nd ed. Belmont, CA: Duxbury Press; 1996.
31.Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Piatt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196203.
32.Petherick, ES, Dalton, JE, Moore, PJ, Cullum, N. Methods for identifying surgical wound infection after discharge from hospital: a systematic review. BMC Infect Dis 2006;6:170.
33.Mannien, J, Wille, JC, Snoeren, RL, van den, HS. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands. Infect Control Hosp Epidemiol 2006;27:809816.
34.Monge Jodra, V, Sainz de Los Terreros Soler, L, Diaz-Agero, C, Saa Requejo, CM, Plana Farras, N. Excess length of stay attributable to surgical site infection following hip replacement: a nested case-control study. Infect Control Hosp Epidemiol 2006;27:12991303.
35.Alfonso, JL, Pereperez, SB, Canoves, JM, Martinez, MM, Martinez, IM, Martin-Moreno, JM. Are we really seeing the total costs of surgical site infections? A Spanish study. Wound Repair Regen 2007;15:474481.
36.Delgado-Rodriguez, M, Medina-Cuadros, M, Bueno-Cavanillas, A, Martinez-Gallego, G, Dierssen, T, Sillero-Arenas, M. Comparison of two procedures to estimate the hospital stay attributable to nosocomial infection: matched cohort study versus analysis of covariance of the total unmatched cohort. J Clin Epidemiol 1997;50:773778.

Related content

Powered by UNSILO

Economic Burden of Surgical Site Infections at a European University Hospital

  • Walter P. Weber (a1), Marcel Zwahlen (a2), Stefan Reck (a1), Chantal Feder-Mengus (a1), Heidi Misteli (a1), Rachel Rosenthal (a1), Daniel Brandenberger (a1), Daniel Oertli (a1), Andreas F. Widmer (a3) and Walter R. Marti (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.