Excess costs associated with common healthcare-associated infections in an Iranian cardiac surgical unit

Abstract

Healthcare-associated infection (HCAI) following open heart surgery is not only a major cause of mortality and morbidity, but also carries higher costs. There are limited data on the additional costs due to HCAI in non-western countries. To estimate the direct cost of the four most common HCAIs in an Iranian sample, we studied 1191 patients admitted for elective open heart surgery. HCAIs were defined using the National Nosocomial Infections Surveillance criteria (Centers for Disease Control and Prevention, Atlanta, GA, USA). The financial costs of length of stay per day in hospital, paraclinical services, medications, instruments, and operating room were provided by the hospital's finance department. The contribution of HCAI to excess direct medical costs in patients with HCAI was assessed by multivariable linear regression. In the study population, the mean age was 57.3±11.9 years, 857 (72.0%) were men, and 64 (5.4%) developed HCAI. In total there were 73 infections of which the most common was surgical site infection (49.3%), followed by urinary tract infection (20.5%), bloodstream infection (16.5%), and pneumonia (13.7%). After adjustment for other confounders HCAI remained associated with excess direct medical costs (β=1707.06, SE=90.84; P < 0.001). The medical costs in patients with HCAI were almost twice those in patients without HCAI. More than half of the excess cost was attributable to prolonged hospitalisation.