PIH2 - CLINICAL AND DEMOGRAPHIC RISK FACTORS AND COSTS OF SURGICAL SITE INFECTION FOLLOWING HYSTERECTOMY

Abstract

Abdominal hysterectomy (AH) is a commonly undertaken surgical procedure with associated SSI rates ranging from 3.5% to 5%. An increased risk of infection has been found in association with diabetes, smoking, respiratory co-morbidities and obesity. This study was extended to explore current SSI rates and risk factors for SSI, and estimate costs of SSI after hysterectomy. Patients who had AH from 2014-2017 were identified in MarketScan Commercial, Medicare and Medicaid administrative claims databases. All patients were categorized by demographic and clinical co-morbidities using all 31 domains of the Elixhauser Comorbidity Index. Additional factors included smoking, site of admission (emergency vs inpatient vs outpatient locations) and payer. SSIs were identified from 1 to 180 days post-operatively using diagnostic codes of superficial or deep incisional SSI. Logistic regression models were developed to evaluate variables associated with SSI. Generalized linear regression models were built and adjusted total payments in US$ with or without SSI were estimated using least squares means with assessment of the difference in all-cause costs up to 6 months post-HA. A total of 128,146 patients with AH were included, with mean Elixhauser index 1.8 (SD: 1.7) and age 46.8 (SD: 9.9), 83.5% were commercially insured, 12.8% were insured by Medicare and 3.7% by Medicaid. Co-morbidities included obesity (16.9%), depression (17.5%), smoking (1.0%), alcohol abuse (0.9%) and drug use (1.7%). SSI was identified in 4.8% patients. The main risk factors for infection included Medicaid enrollment status (OR: 1.7 (95%CI: 1.6-1.8)), obesity (OR: 1.1 (95%CI: 1.0-1.8)), Crohn’s Disease (OR: 1.9 (95%CI: 1.4-2.6)), diabetes with complications (OR: 1.1 (95%CI: 1.0-1.2)) and Emergency admissions (OR: 1.6 (95%CI: 1.3-1.9)). Payer costs of infection over the 6 months period averaged US$ 18,547 (95%CI: 17,898-19,211). Infection following abdominal hysterectomy are associated with many clinical and socio-economic factors and result in significant costs.