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The return of investment of hospital-based surgical quality improvement programs in reducing surgical site infection at a Canadian tertiary-care hospital

  • Sasha van Katwyk (a1) (a2), Kednapa Thavorn (a1) (a2) (a3), Doug Coyle (a2), Husein Moloo (a1) (a4), Alan J. Forster (a1) (a3) (a5), Timothy Jackson (a6) (a7) and David Schramm (a1) (a8)...



We performed a return-on-investment analysis comparing the investment in surgical site infection (SSI) prevention programs in a hospital setting to the savings from averted SSI cases.


A retrospective case costing study using aggregated patient data to determine the incidence and costs of SSI infection in surgical departments over time. We calculated return on investment to the hospital and conducted several sensitivity and scenario analyses.


Data were compiled for the Ottawa Hospital (TOH), a Canadian tertiary-care teaching institution.


We used aggregated records for all hospital patients who underwent surgical procedures between April 2010 and January 2015.


We estimated the potential cost savings of the hospital’s surgical quality improvement program, namely the Surgeons National Surgical Quality Improvement Program (NSQIP) and the Comprehensive Unit-based Safety Program (CUSP).


From 2010 to 2016, TOH invested C$826,882 (US$624,384) in surgical quality improvement programs targeting SSI incidence and accrued C$1,885,110 (US$1,423,460) in cumulative savings from averted SSI cases, generating a return of $2.28 (US$3.02) per dollar invested (95% confidence interval [CI], −0.67 to 7.37). The study findings are sensitive to the estimated cost to the hospital per SSI case and the rate reduction attributable to the prevention program.


The NSQIP and CUSP have produced a positive return on investment at TOH; however, the result rests on several assumptions. This positive return on investment is expected to continue if the hospital can continue to reduce SSI incidence at least 0.25% annually without new investments. Findings from this study highlight the need for continuous program evaluation of the quality improvement initiatives.


Corresponding author

Author for correspondence: Kednapa Thavorn, PhD, Ottawa Hospital Research Institute, The Ottawa Hospital, 501 Smyth Road, PO Box 201B, Ottawa, ON, Canada K1H 8L6. E-mail:


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Cite this article: van Katwyk S, et al. (2019). The return of investment of hospital-based surgical quality improvement programs in reducing surgical site infection at a Canadian tertiary-care hospital. Infection Control & Hospital Epidemiology 2019, 40, 125–132. doi: 10.1017/ice.2018.294



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