The Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections

Abstract

ObjectiveThis study assessed the additional healthcare utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures. MethodsThis retrospective observational cohort study used commercial and Medicare Advantage claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year post-discharge. ResultsThe total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days; all p < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.8 to 25.1; all p ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio of 1.6; p = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI versus matched comparison cohorts for the index episode and six months and one year post-discharge. Average adjusted one-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (p < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (p < 0.05). ConclusionPatients with SSIs experienced higher LOS, readmission rates, total medical costs, and higher mortality for some populations compared to their matched comparison cohorts during the first year post-discharge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.