Abstract
Background: Sternal wound infections (SWIs) can be some of the most complex surgical-site infections (SSIs) and pose a considerable risk following coronary artery bypass graft surgery (CABG).Objective: To capture the cost burden of SWIs following CABG across European countries.Methods: We modeled a standardized care pathway for CABG, starting at the point of surgery and extending to 1-year post surgery. The Markov model captures the incidence and cost of an SWI (deep or superficial SWIs). The cost burden is calculated from a hospital perspective such that the main inputs relating to costs were intensive-care-unit (ICU) and general-ward (GW) days. Outpatient care, not in the hospital setting, has no cost in this analysis. Model input parameters were taken from Eurostat and a review of published, peer-reviewed literature. European countries were included in this analysis when values for 50% of the required input parameters per country were identified. Missing data points were interpolated from available data. The robustness of results was assessed via probabilistic sensitivity analysis.Results: Full required input data were available for 8 European countries; a further 18 countries had sufficient data for analysis. The median (interquartile range) for SWI incidence across the 26 countries was 3.9% (2.9–5.6%). The total burden for all 26 countries of SWIs after CABG was €170.8 million. These costs were made up of 25,751 additional ICU days, 137,588 additional GW days, and 7,704 readmissions. The mean cost of an SWI ranged from €8,924 in Poland to €21,321 in Denmark. Relative to the costs of post-CABG care without an SWI complication, the incremental cost of an SWI was highest in Greece (24.9% increase) and lowest in the UK (3.8% increase) with a median (interquartile range) of 12% (10–16%) across all 26 countries.Conclusions: SWIs following CABG present a considerable burden to healthcare budgets.
Highlights
Surgical-site infections (SSIs) can be a serious complication that may present in the days or weeks following a surgical intervention
The mean cost of an Sternal-wound infections (SWIs) ranged from e8,924 in Poland to e21,321 in Denmark
Relative to the costs of post-coronary artery bypass graft surgery (CABG) care without an SWI complication, the incremental cost of an SWI was highest in Greece (24.9% increase) and lowest in the United Kingdom (UK) (3.8% increase) with a median of 12% (10–16%) across all 26 countries
Summary
Surgical-site infections (SSIs) can be a serious complication that may present in the days or weeks following a surgical intervention. In the 50 years since Rene Favaloro pioneered coronary artery bypass graft surgery (CABG), it has become a commonly performed procedure to improve blood flow to the heart in patients suffering from severe coronary heart disease. During CABG, the afflicted part of the coronary artery is replaced by a segment taken from another major blood vessel (the harvest site). Due to the highly invasive nature of CABG procedures, post-surgical infections are especially dangerous. SSIs linked to CABG can occur either at the harvest site or at the sternum, the latter generally being considered more detrimental to patient outcomes. Sternal-wound infections (SWIs) are further divided into superficial, deep, and organspace SWIs. Sternal wound infections (SWIs) can be some of the most complex surgical-site infections (SSIs) and pose a considerable risk following coronary artery bypass graft surgery (CABG)
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