Browse > Article
http://dx.doi.org/10.4332/KJHPA.2011.21.1.044

The effect of surgical site infection on the length of stay and health care costs  

Chang, Jin-Hee (The Health Insurance Review and Assessment Service)
Kim, Kyoung-Hoon (The Health Insurance Review and Assessment Service)
Kwon, Soon-Man (Graduate School of Public Health, Seoul National University)
Yeom, Seon-A (The Health Insurance Review and Assessment Service)
Park, Choon-Seon (The Health Insurance Review and Assessment Service)
Publication Information
Health Policy and Management / v.21, no.1, 2011 , pp. 44-60 More about this Journal
Abstract
Background : Surgical site infection(SSI) is one of the important nosocomial infections with pneumonia, urinary tract infection. SSI increases mortality, morbidity, length of stay, and costs for postoperative patients. The purpose of this study was to estimate length of stay(LOS) and health care costs from SSI using the large observational data. The ultimate objective was to show the effect of prevention of SSI. Method : This study used antibiotic prophylaxis evaluation data and claims data of the HIRA(Health Insurance Review and Assessment Service). The study population included 18,361 patients who underwent gastric surgery, endoscopic cholecystectomy, colon surgery, hysterectomy, cesarean section in nationwide hospitals from August to October 2007. SSI group and non-SSI group were matched according to propensity score resulted from logistic regression. The paired t-test was used to compare the difference of the LOS and health care costs between SSI group and non-SSI group. Results : The 598 cases of SSI were detected of total subjects, and the crude SSI rate was 3.3%. For each surgery, SSI rates were 5.5% for gastric surgery, 4.7% for cholecystectomy, 6.6% for colon surgery, 2.6% for hysterectomy, and 1.6% for cesarean section. The 596 cases of SSI and the 596 cases of non-SSI were matched by propensity score. The LOS of SSI group was longer than that of non-SSI group, and the difference was statistically significant. Health care costs of SSI group was more than that of non-SSI group which was significant. Conclusions : SSI increased apparently the LOS and healthcare costs. The economic loss might affect the cost of national healthcare as well as patients and hospitals. This study provided the evidence that the healthcare expenditure could be reduced by preventing SSI.
Keywords
Surgical site infection; Length of stay; Health care costs; Propensity score matching;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 이혜령. 일반외과 환자의 수술 후 창상감염에 영향을 미치는 요인[석사학위논문]. 강원도: 강원대학교 대학원;2002.
2 전국병원감시체계. 전국병원감염감시체계(KONIS) 매뉴얼 2008.
3 한달선, 김병익, 배상수, 김동현, 최영호, 이상일 등. 병원감염이 진료비용에 미치는 영향에 대한 연구. 보건경제연구 1997;3:84-106.
4 5 Million Lives Campaign. Getting Started Kit: Prevent Surgical Site Infections How-to Guide. Cambridge, MA: Institute for Healthcare Improvement;2008.
5 Anderson DJ, Kaye KS, Classen D, Arias KM, Podgorny K, Burstin H, et al. Strategies to prevent surgical site infections in acute care hospitals. Infection Control and Hospital Epidemiology 2008;29 Suppl 1:S51-61.   DOI   ScienceOn
6 Coello R, Charlett A, Wilson J, Wardc V, Pearsona A, Borriello P, et al. Adverse impact of surgical site infections in English hospitals. Journal of Hospital Infection 2005;60(2):93-103.   DOI   ScienceOn
7 Connors AF Jr, Speroff T, Dawson NV, Thomas C, Harrell FE Jr, Wagner D, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. the Journal of the American Medical Association 1996;276(11):889-897.   DOI
8 Xuezheng S, Zhao Y. Generalized Mcnemar's test for homogeneity of the marginal distributions. SAS Global Forum 2008 paper 382-2008.
9 Yang G, Stemkowski S, Saunders W. A review of propensity score application in healthcare outcome and epidemiology. PharmaSUG Conference Denver, CO. 2007.
10 Yasunaga H, Ide H, Imamura T, Ohe K. Accuracy of economic studies on surgical site infection. Journal of Hospital Infection 2007;65(2):102-107.   DOI   ScienceOn
11 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. Infection Control and Hospital Epidemiology 1999;20(11):725-730.   DOI   ScienceOn
12 Love TE. Using propensity score methods effectively. Cleveland Chapter of the American Statistical Association Fall Workshop;2004.
13 김준명. 병원감염의 국내 발생현황. 대한내과학회지 1999;57(4):572-577.
14 국민건강보험공단. 비급여 진료비 실태와 관리방안. 2007.
15 김경훈, 박춘선, 장진희, 김남순, 이진서, 최보람 등. 요양급여적정성 평가자료를 이용한 예방적 항생제 사용과 수술부위감염 발생의 관련성 연구. 예방의학회지 2010;43(3):235-244.   과학기술학회마을   DOI   ScienceOn
16 김의석, 장윤정, 박윤수, 강지혜, 박신영, 김정연 등. 2007년 다기관 수술부위감염감시 체계 결과보고: 인공관절치환술과 위절제술. 병원감염관리 2008;13(1):32-41.
17 Parsons LS. Reducing bias in a propensity score matched-pair sample using greedy matching techniques. SAS SUGI 2001;214-226.
18 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infection Control and Hospital Epidemiology 1999;20(4):247-278.   DOI
19 Monge Jodra V, Sainz de Los Terreros Soler L, Diaz-Agero Perez C, Saa Requejo CM, Plana Farras N. Excess length of stay attributable to surgical site infection following hip replacement: a nested case-control study. Infection Control and Hospital Epidemiology 2006;27(12):1299-1303.   DOI   ScienceOn
20 Murray PK, Singer M, Dawson NV, Thomas CL, Cebul RD. Outcomes of rehabilitation services for nursing home residents. Archives of Physical Medicine and Rehabilitation 2003;84(8):1129-1136.   DOI   ScienceOn
21 Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerging Infectious Diseases 2003;9(2):196-203.   DOI   ScienceOn
22 Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK, et al. Stents versus coronary-artery bypass grafting for left main coronary artery disease. The New England Journal of Medicine 2008;358(17):1781-1792.   DOI   ScienceOn
23 D'Agostino RB Jr. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statistics in medicine 1998;17(19):2265-2281.   DOI   ScienceOn
24 Eagye KJ, Nicolau DP. Deep and organ/space infections in patients undergoing elective colorectal surgery: incidence and impact on hospital length of stay and costs. American Journal of Surgery 2009;198(3):359-367.   DOI   ScienceOn
25 Jenney AW, Harrington GA, Russo PL, Spelman DW. Cost of surgical site infections following coronary artery bypass surgery. ANZ Journal of Surgery 2001;71(11):662-664.   DOI   ScienceOn
26 Thuny F, Beurtheret S, Mancini J. The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis. European Heart Journal 2009;26.
27 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. Infection Control and Hospital Epidemiology 2002;23(4):183-189.   DOI   ScienceOn
28 Graves N, Nicholls TM, Morris AJ. Modeling the costs of hospital-acquired infections in New Zealand. Infection Control and Hospital Epidemiology 2003;24(3):214-223.   DOI   ScienceOn
29 Gum PA, Thamilarasan M, Watanabe J, Blackstone EH, Lauer MS. Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: A propensity analysis. the Journal of the American Medical Association 2001;286(10):1187-1194.   DOI   ScienceOn
30 Hollenbeak CS, Murphy D, Dunagan WC, Fraser VJ. Nonrandom selection and the attributable cost of surgical-site infections. Infection Control and Hospital Epidemiology 2002;23(4):177-182.   DOI   ScienceOn
31 Kaltenbach L. How to use propensity score analysis. 2008.
32 Kasatpibal N, Thongpiyapoom S, Narong MN, Suwalak N, Jamulitrat S. Extra charge and extra length of postoperative stay attributable to surgical site infection in six selected operations. Journal of The Medical Association of Thailand 2005;88(8):1083-1091.
33 박은숙, 김경식, 이우정, 장선영, 최준용, 김준명. 수술부위감염에 따른 경제적 손실. 병원감염관리 2005;10(2):57-64.
34 사공필용. 예방적 항생제 사용양상과 수술부위감염률의 관련성[석사학위논문]. 서울: 서울대학교 대학원;2007.
35 이신영. 일개 종합병원의 수술부위감염에 영향을 미치는 요인[석사학위논문]. 서울: 고려대학교 대학원;2004.
36 이재혁, 한호성, 민석기, 이현국, 이주호, 김영우 등. 외과 환자의 수술창감염에 대한 전향적인 연구. 대한외과학회지 2004;66(2):133-137.   과학기술학회마을