Skip to main content Accessibility help
×
Home

A Prospective Study of Outcomes, Healthcare Resource Utilization, and Costs Associated With Postoperative Nosocomial Infections

  • Loreen A. Herwaldt (a1) (a2) (a3), Joseph J. Cullen (a4), David Scholz (a2) (a5), Pamela French (a6), M. Bridget Zimmerman (a7), Michael A. Pfaller (a8) (a2), Richard P. Wenzel (a1) (a3) (a9) and Trish M Perl (a1) (a10)...

Abstract

Objective.

We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources.

Design.

The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes.

Setting.

A large tertiary care medical center and an affiliated Veterans Affairs Medical Center.

Patients.

A total of 3,864 surgical patients.

Results.

The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population.

Conclusion.

Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.

Copyright

Corresponding author

C520-1 GH, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 -1081 (loreen-herwaldt@uiowa.edu)

References

Hide All
1.Horan, TC, Culver, DH, Gaynes, RP, et al. Nosocomial infections in surgical patients in the United States, January 1986- June 1992. Infect Control Hosp Epidemiol 1993; 14:7380.
2.Wenzel, RP, Pfaller, MA. Feasible and desirable future targets for reducing the costs of hospital infections. J Hosp Infect 1991; 18(Suppl A):9498.
3.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost and prevention. Infect Control Hosp Epidemiol 1996; 17:552557.
4.Fridkin, SK, Pear, SM, Williamson, TH, et al. The role of understaffing in central venous catheter–associated bloodstream infection. Infect Control Hosp Epidemiol 1996; 17:150158.
5.Taylor, GJ, Mikell, FL, Moses, HW, et al. Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications. Am J Cardiol 1990; 65:309313.
6.Weintraub, WS, Jones, EL, Craver, J, et al. Determinants of prolonged length of stay after coronary bypass surgery. Circulation 1989; 80:276284.
7.Perl, TM, Cullen, JJ, Wenzel, RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. The Mupirocin and the Risk of Staphylococcus aureus Study Team. New Engl J Med 2002; 346:18711877.
8.Herwaldt, LA, Swartzendruber, SK, Zimmerman, MB, et al. Hemorrhage after coronary artery bypass graft procedures. Infect Control Hosp Epidemiol 1998; 19:916.
9.Green, JW, Wenzel, RP. Postoperative wound infections: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg 1977; 185:264268.
10.Kollef, MH, Sharpless, L, Vlasnik, J, et al. The impact of nosocomial infection on patient outcomes following cardiac surgery. Chest 1997; 112:666675.
11.Hollenbeak, CS, Murphy, DM, Koenig, S, et al. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest 2000; 118:397402.
12.Rebollo, MH, Bernal, JM, Llorca, J, et al. Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg 1996; 112:908913.
13.Kirkland, KB, Briggs, JP, Trivette, SL, et al. 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.
14.Reilly, J, Twaddle, S, McIntosh, J, et al. An economic analysis of surgical wound infection. J Hosp Infect 2001; 49:245249.
15.Coello, R, Glenister, H, Fereres, J, et al. The cost of infection in surgical patients: a case-control study. J Hosp Infect 1993; 25:239250.
16.Jenney, AW, Harrington, GA, Russo, PL, et al. Cost of surgical site infections following coronary artery bypass surgery. Aust NZ J Surg 2001; 71:662664.
17.Erbaydar, S, Akgun, A, Eksik, A, et al. Estimation of increased hospital stay due to nosocomial infections in surgical patients: comparison of matched groups. J Hosp Infect 1995; 30:149154.
18.Asensio, A, Torres, J. Quantifying excess length of postoperative stay attributable to infections: a comparison of methods. J Clin Epidemiol 1999; 52:12491256.
19.Merle, V, Germain, J-M, Chamouni, P, et al. Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol. Am J Infect Control 2000; 28:109115.
20.Zoutman, D, McDonald, S, Vethanayangan, D. Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center. Infect Control Hosp Epidemiol 1998; 19:254259.
21.Schulgen, G, Kropec, A, Kappstein, I, et al. Estimation of extra hospital stay attributable to nosocomial infections: heterogeneity and timing of events. J Clin Epidemiol 2000; 53:409417.
22.Larson, L. Cost determination and analysis. In: Bootman, JL, Townsend, RJ, McGhan, WF, eds. Principles of Pharmacoeconomics. 2nd ed. Cincinnati: Harvey Whitney Book Company; 1996:4459.
23.Finkler, SA. The distinction between costs and charges. Ann Intern Med 1982;96:102109.
24.Cruse, PJE, Foord, R. The epidemiology of wound infection: a 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980; 60:2740.
25.Wenzel, RP. The economics of nosocomial infections. J Hosp Infect 1995; 31:7987.

Metrics

Altmetric attention score

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