Abstract
Postoperative infections after a fracture exert tremendous costs on the health care system. However, the patient economic burden associated with a postoperative infection is unclear. To evaluate the association between a postoperative infection and long-term income among patients with surgically treated fractures. A retrospective cohort study linked academic trauma center data with Maryland tax records using inverse probability of treatment weighting to estimate between-group differences among 11 673 adults who underwent surgery to treat fractures of the extremities or pelvis between January 1, 2003, and December 31, 2016. Statistical analysis was performed from November 5, 2019, to August 30, 2020. A postoperative infection within 1 year of injury. The primary outcome was the annual household income up to 6 years after injury. Household income incorporates multiple types of income, including wage earnings, taxable Social Security benefits, workers' compensation, and disability benefits. Secondary outcomes included individual earnings, Social Security benefits, unemployment benefits, and catastrophic income loss. The study included 11 673 patients (7756 male patients [66.4%]; mean [SD] age, 45.2 [19.2] years) with a mean (SD) preinjury household income of $30 505 ($89 030). A total of 403 patients (3.5%) had a postoperative infection. Postoperative infections were associated with a $6080 annual decrease (95% CI, -$12 114 to -$47; P = .048) in household income in the 6 years after injury. Postoperative infections were associated with a 6.6% increase (95% CI, 4.9%-8.3%; P < .001) in the risk of catastrophic wage loss within 2 years of the fracture and were associated with a 45% increase in the odds of receiving Social Security benefits (odds ratio, 1.45; 95% CI, 1.25-1.68; P < .001). However, incurring a postoperative infection was not associated with an increase in the value of the Social Security benefits received. This study suggests that postoperative infections have significant and sustained income-associated implications for patients who experience a fracture. Current Social Security mechanisms may not offset the decreased income.
Highlights
Postoperative infections were associated with a 6.6% increase in the risk of catastrophic wage loss within 2 years of the fracture and were associated with a 45% increase in the odds of receiving Social Security benefits
This study suggests that postoperative infections have significant and sustained income-associated implications for patients who experience a fracture
Meaning This study suggests that postoperative infections have significant and sustained income-associated implications for patients with a fracture
Summary
Postoperative infections exert a tremendous cost and resource burden on the health care system.[1,2,3] Patients with postoperative infections require additional treatment, more diagnostic testing, readmission to the hospital or prolonged hospital stay, and other additional uses of scarce health care resources.[4,5] The impact of postoperative infections likely manifests more broadly in the economy through lost capacity and productivity of patients and their caregivers.[6,7] Many postoperative infections can be systematically prevented through improved health care quality and infection prevention policies.[8,9] Previous studies have demonstrated that the cost of infection prevention is typically much lower than the cost of treating the complication.[3,4,8,9,10] there is a clear gap in knowledge on the long-term association of a postoperative infection with the patient’s economic well-being.[9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
