Abstract
PurposeSurgical site infection (SSI) occurs in up to 25% of patients after elective laparotomy. We aimed to determine the effect of SSI on healthcare costs and patients’ quality of life.MethodsIn this post hoc analysis based on the RECIPE trial, we studied a 30-day postoperative outcome of SSI in a single-center, prospective randomized controlled trial comparing subcutaneous wound irrigation with 0.04% polyhexanide to 0.9% saline after elective laparotomy. Total medical costs were analyzed accurately per patient with the tool of our corporate controlling team which is based on diagnosis-related groups in Germany.ResultsBetween November 2015 and May 2018, 456 patients were recruited. The overall rate of SSI was 28.2%. Overall costs of inpatient treatment were higher in the group with SSI: median 16.685 €; 19.703 USD (IQR 21.638 €; 25.552 USD) vs. median 11.235 €; 13.276 USD (IQR 11.564 €; 13.656 USD); p < 0.001. There was a difference in surgery costs (median 6.664 €; 7.870 USD with SSI vs. median 5.040 €; 5.952 USD without SSI; p = 0.001) and costs on the surgical ward (median 8.404 €; 9.924 USD with SSI vs. median 4.690 €; 5.538 USD without SSI; p < 0.001). Patients with SSI were less satisfied with the cosmetic result (4.3% vs. 16.2%; p < 0.001). Overall costs for patients who were irrigated with saline were median 12.056 €; 14.237 USD vs. median 12.793 €; 15.107 USD in the polyhexanide group (p = 0.52).ConclusionSSI after elective laparotomy increased hospital costs substantially. This is an additional reason why the prevention of SSI is important. Overall costs for intraoperative wound irrigation with saline were comparable with polyhexanide.
Highlights
Surgical site infection (SSI) is a common complication of abdominal surgery
In the RECIPE trial (Reduction of postoperative wound infections by antiseptica?) conducted in the Department of General, Visceral and Vascular Surgery of the Charité – Campus Benjamin Franklin Berlin, we could show that intraoperative subcutaneous wound irrigation with
In the RECIPE trial, 456 patients were recruited and 393 (86.2%) completed the follow-up 30 days postoperatively [6]. Patients of this post hoc analysis had an average age of 58.3 ± 16.2 years
Summary
Surgical site infection (SSI) is a common complication of abdominal surgery. Previous studies showed SSI rates after visceral surgery as high as 20% [1, 2]. SSI results in up to one million additional days of hospitalization per year and considerable healthcare costs in Germany [3]. In the USA, attributable costs for SSI vary between $10.443 and $25.546 per infection [4, 5]. SSI is a huge burden for the patient and has a relevant impact on the patient’s satisfaction with healthcare. There is a lack of studies concerning the quality of life of patients with SSI in abdominal surgery. In the RECIPE trial (Reduction of postoperative wound infections by antiseptica?) conducted in the Department of General, Visceral and Vascular Surgery of the Charité – Campus Benjamin Franklin Berlin, we could show that intraoperative subcutaneous wound irrigation with
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