PMD15 ASSESSMENT OF THE RISK AND ECONOMIC BURDEN OF SURGICAL SITE INFECTION FOLLOWING COLORECTAL SURGERY USING A US LONGITUDINAL DATABASE: IS THERE A ROLE FOR INNOVATIVE ANTIMICROBIAL WOUND CLOSURE TECHNOLOGY TO REDUCE THE RISK OF INFECTION?

Abstract

Colorectal surgical procedures place substantial burden on healthcare systems because of the high complication risk, especially surgical site infections. The purpose of this study was to determine the incidence and true cost of infections after colorectal surgery and potential economic impact of using antimicrobial wound closure to improve patient outcomes. This was a retrospective observational cohort analysis and probabilistic cost analysis, using the IBM® MarketScan® Commercial and Medicare Claims database. A total of 107,665 patients undergoing colorectal surgery between 2014 and 2018 in the United States were identified. Rate of infection was identified between 3-180 days postoperatively. Logistic models were used to evaluate risk for infection and generalized linear models were developed to estimate 2018 inflation-adjusted payer cost of infection within 24 months post surgery. Potential cost avoidance from avoided infections using antimicrobial sutures were further estimated using a probabilistic decision-tree using Monte Carlo simulation. Post-operative infections were diagnosed in 23.9% of patients (4.0% superficial incisional (SS) and 19.9% deep incisional/organ-space (DIOS)). Risk factors for DIOS infections included obesity, and admission type (emergency vs elective) among others. After 12-months, payer costs associated with superficial incisional and deep incisional/organ-space infections averaged $36,196 (9% confidence interval (CI): 32,840-39,691) and $77,043 (95%CI: $75,179-$78,941) for Commercial payers and $17,323 (95% CI: $12,805-$22,191) and $55,089 (95%CI: $52,340-$57,940) for Medicare, respectively. Use of antimicrobial suture wound closure for colorectal surgery was estimated to reduce mean payer costs by $1,435-$2,405 per patient compared with traditional wound closure. Infection cost burden was found to be higher than previously reported, with payer costs increasing over a 24-month postoperative period. Findings in this study were estimated using modeling techniques with inherent limitations, however, results suggest overall savings from use of antimicrobial sutures as a component of a comprehensive evidence-based surgical care bundle for reducing infection risk.