Burden Of Surgical Site Infections Research Articles

Prevalence of surgical site infections in a tertiary care teaching hospital in Goa, India: a cross-sectional study

Background: Surgical site infections (SSIs) are a major category of healthcare-associated infections (HAIs), particularly in surgical settings. They lead to extended hospital stays, increased morbidity, and financial burden. The study was conducted in the surgical wards of Goa medical college, a tertiary care hospital, to assess the prevalence of SSIs and identify the key bacterial pathogens and associated risk factors. Methods: A cross-sectional, prospective study design was employed, involving 378 patients aged over 18 years admitted for surgical procedures. Data collection included daily follow-up for signs of infection, identification of bacterial pathogens, and analysis of potential risk factors such as age, type of surgery, duration of postoperative drain, length of hospital stays, and wound classification. Statistical analyses were conducted using SPSS software, with significance set at p<0.05. Results: The study identified an SSI prevalence of 12.69% among the participants, with Pseudomonas being the most common causative agent. Significant risk factors included extended postoperative drain duration, longer hospital stays, emergency surgical procedures, and surgeries involving contaminated or clean-contaminated wounds. Patients with prolonged postoperative drains had a markedly higher incidence of SSIs (63.63%). Conclusions: The findings reveal a considerable burden of SSIs in the studied setting, with high infection rates in patients undergoing prolonged drain usage, emergency surgeries, and surgeries on contaminated wounds. Strengthening infection prevention measures, particularly in high-risk cases, and enforcing strict adherence to hygiene and sterilization practices are critical. Enhanced infection surveillance programs and targeted interventions could help reduce SSI rates, improve patient outcomes, and minimize healthcare costs.

Surgical Site Infection after Primary Open Surgery for Laryngeal Cancer in a Tertiary Hospital in Belgrade, Serbia: A 10-Year Prospective Cohort Study.

Surgical site infection (SSI) in laryngeal cancer (LC) patients significantly increases morbidity and may postpone adjuvant therapy. Additionally, SSI can prolong hospitalization, thus representing a burden for the healthcare system. Most of the published studies refer to SSI after salvage laryngectomy. The present prospective cohort study aimed to clarify the incidence and factors associated with SSI in patients after primary open surgery for LC. Through regular hospital surveillance of patients who underwent primary partial or total laryngectomy, we gathered 24 putative factors and identified SSI from 2013 to 2022. Patients with SSI were compared with patients without SSI. SSI was observed in 21 (6.6%) of 319 patients. ULRA showed that the occurrence of SSI was significantly associated with the American Society of Anesthesiologists (ASA) score, other postoperative healthcare-associated (HAI) infection, T classification, N classification, advanced clinical stage (III-IV), length of stay (LOS), duration of drainage, and the National Healthcare Safety Network (NHSN) risk index. Multivariate logistic regression analysis identified two independent factors associated with SSI occurring in these patients: duration of drainage (RR (relative risk) 1.593; 95% CI 1.159-2.189; p = 0.004) and LOS (RR: 1.074; 95% CI: 1.037-1.112; p < 0.001). Our study provided insight into the burden of SSI in LC patients, highlighting several priority areas and targets for quality improvement.

Disease burden of main bacterial infections in Japan, 2015–2020: A population-level study

IntroductionComprehensive evidence about the burden of infectious diseases in the Western Pacific Region is scarce. We thus examined the disease burden of infectious diseases in Japan in terms of disability-adjusted life years (DALYs). MethodsWe extracted national claims data from Japan's universal health insurance system to estimate the burden of disease for selected infections between 2015 and 2020 using DALYs. The mortality rate, disability duration and severity weight of each disease were estimated based on national data and literature reviews. ResultsDisease burden per 100,000 population was 1307.0 in 2015 and 972.1 in 2020 for bloodstream infections (BSI), 796.5 DALYs in 2015 and 498.9 DALYs in 2020 for pneumonia, 171.5 in 2015 and 149.4 in 2020 for meningitis and 11.6 in 2015 and 11.4 in 2020 for urinary tract infections (UTI). Only surgical site infections (SSI) showed a slightly increasing trend over the 5-year period, from 2.2 in 2015 to 2.8 in 2020. ConclusionsOur results showed that the disease burden of the five major infectious diseases was higher in Japan than in other countries. However, while the burden of SSI increased, the burden of pneumonia, meningitis, BSI and UTI gradually decreased year on year. The possible causes of the decreased morbidity should be examined in future work.

Surgical Site Infections in Major Lower Limb Amputation: An International Multicentre Audit (SIMBA): Study Protocol

Background: Over 3,000 major lower limb amputations (MLLA) occur in the UK per annum. A significant proportion of patients following MLLA will go on to develop a surgical site infection (SSI). SSIs can range from a simple superficial infection that is treated with oral antibiotic therapy to deeper infections which can lead to wound dehiscence and, ultimately, surgical revision. SSIs can have a significant impact on patient mobility, function, morbidity and mortality as well as wider effects on carers, community services and hospital systems. Despite these potential impacts there are limited data to determine the rate of SSI in patients undergoing MLLA, adjuncts that successfully prevent SSI, factors that predispose patients to SSI and compliance with national guidance set out by key stakeholders in vascular surgical care. Methods: To address this gap in evidence we propose a large, international, prospective, collaborative audit that aims to compare current practice against recommendations set out by the National Institute of Health and Care Excellence and The Vascular Society of Great Britain and Ireland and to determine the frequency of significant outcomes related to SSI (as defined by the Centre for Disease Control) in consecutive patients undergoing MLLA over an 8-month period including the incidence of SSI, wound dehiscence and surgical revision at 30 days, frequency of use of adjuncts designed to reduce SSI and predictors of SSI. Outcomes will also be captured at 1 year post-MLLA if funding permits. Discussion: This multicentre audit will allow us to describe the incidence and burden of SSI and wound dehiscence in patients undergoing MLLA. The strengths of this audit will lie in its use of contemporaneous data collection from numerous hospitals and the in-depth data collection focusing primarily on MLLA SSI. It is anticipated that the audit will provide impactful data for future comparisons with global practice and support the design of robust and meaningful studies.

A prospective study of post-operative surgical site infections after open gastrointestinal surgeries

Background: Surgical site infections (SSIs) are infections of the tissues, organs, or spaces exposed by surgeons while performing an invasive procedure. SSI is one of the most common healthcare-associated infections, but its importance as a health-care priority is not fully understood, and limited work has been published defining the role of surgeons in SSIs. Aims and Objectives: In the present study, we assess the burden of SSI after gastrointestinal (GI) surgery in a tertiary care hospital in the Central India. Materials and Methods: The present study was conducted on patients admitted to Gandhi Medical College-affiliated Hamidia Hospital, Bhopal, in the General Surgery Department. The study included 207 patients who underwent emergency/routine GI surgeries between September 2020 and April 2022. Patient characteristics and laboratory data were recorded on a pre-designed form, and all patients were evaluated postoperatively for soakage along with culture and antibiotic testing. Results: The overall incidence of SSI was 42.51% and its distributions between emergency and routine surgeries were 22.7% and 19.8%, respectively. SSI was predominant in male patients. White blood cell level was significantly associated between emergency and routine surgeries, while Hb level, serum protein level, and the time required for surgery were insignificant. SSI under contaminated dirty wounds was prevalent in both emergency and routine surgeries. Klebsiella was the most commonly isolated organism, followed by Escherichia coli. The commonly susceptible antibiotics have been found to be meropenem, pipzo, amikacin, and imipenem. Commonly resistant antibiotics were amoxiclav, ceftriaxone, linezolid, and doxycycline. Conclusion: This paper presents the incidence of SSI in the hospital setting of Central India and the factors that may contribute to the high incidence of SSI. Further research needs to be done to better understand how specific risk factors are responsible for post-operative wound infections in open GI surgery.

Superficial Surgical Site Infection in Hand Surgery: A Cross- sectional Study in a Hand Surgery Unit

Introduction: Superficial surgical site infection (SSI) in hand surgery is generally considered to be less common. Infection of surgical site can lead to poor outcomes. Burden of surgical site infection in hand surgery has not been studied in our part of the world. We sought to determine the prevalence rate superficial surgical site infection in patients undergoing hand surgery. Methods: We used standard definition of CDC National Healthcare Surveillance Network (NHSN) criteria to evaluate 112 consecutive adults undergoing various hand surgery procedures outcome at the end of the second week for superficial SSI. The study was conducted over a period of six month (November 2022 to May 2023). Results: The prevalence of superficial surgical site infection was 6.25% . Among those affected 0.02% cases were diagnosed based on signs and symptoms criteria. In 0.03% patient the wound discharge yielded Staphylococcus aureus. The most common cause requiring hand surgery were workplace injuries, household injuries, and injuries due to road traffic accounting for 45.54%, 26.79%, and 18.75% , respectively. Crushing type of injury which was the most common of all mechanisms of injury. Conclusion: The prevalence rates of hand procedures are low but not negligible. This under-evaluated condition must be more extensively evaluated in a multicenter study involving larger population.

Unveiling the burden of surgical site infections (SSI) and its determinants in tertiary care centre

Surgical site infections (SSIs) are prevalent hospital-acquired infections that pose a significant risk to patients, often leading to complications and even death. The incidence of SSIs can vary among different hospitals due to various factors that influence their development. The objective of this study was to examine the occurrence and determine the factors associated with Surgical Site Infections (SSI). From August 2021 to July 2022, our tertiary care center conducted a retrospective observational study. The surgical sites were carefully assessed and categorized, and infected wounds underwent culture and sensitivity testing. The collected data was then analyzed using SPSS 13 software: Among the 360 patients studied, 78 (22%) developed surgical site infections (SSI). Risk factors for SSI included age, gender, BMI, diabetes, blood transfusion, and longer preoperative waiting time. Staphylococcus aureus was the predominant pathogen, and resistance to tetracycline was common.Surgical site infections (SSI) are prevalent, indicating a high incidence. Among the contributing factors, gender, extremes of BMI, diabetes mellitus, and blood transfusion emerge as influential risk factors associated with the occurrence of SSI.

Economic burden of surgical site infections: Physician assessment method

Economic burden of surgical site infections: Physician assessment method

The burden of appendicitis and surgical site infection of appendectomy worldwide.

Appendicitis is a global abdominal disease and is often treated by appendectomy. Surgical site infection (SSI) is a common complication after an appendectomy that causes a significant burden on health systems. This study aimed to evaluate the trends and variations in the burden of appendicitis by year, region, socioeconomic status, and health expenditure and to assess associated SSI by appendicitis burden, surgical approach, and type of appendicitis. Data on Disability-Adjusted Life Years (DALYs) and the human development index were collected from the Global Burden of Disease (GBD) Study and the United Nations Development Programme, respectively. Studies on SSI after appendectomy using the uniform definition and published in 1990-2021 were retrieved. Between 1990 and 2019, the global age-standardized DALY rate of appendicitis decreased by 53.14%, with the highest burdens in Latin America and Africa. The burden of appendicitis was significantly negatively correlated with HDI (r = -0.743, p<0.001) and health expenditure (r = -0.287, p<0.001). Among 320 published studies on SSI after an appendectomy, 78.44% of studies did not report criteria for SSI diagnosis or adopt a uniform definition. In total, 69 studies with uniform SSI definitions were included. Studies with uniform SSI definitions were recorded poorly in regions with a heavy burden of appendicitis. The SSI of appendectomy was positively correlated with open appendectomy and complicated appendicitis. Uniform SSI definition, promotion of laparoscopic technology, and establishment of SSI special management are needed to decrease the burden of SSI after an appendectomy, especially in developing countries.

Burden and associated risk factors for surgical site infections in General Surgery Department of Ndola Teaching Hospital (NTH) from January to December 2021: A Hospital-based retrospective study

Background: Surgical Site Infections are the second most common type of health care-associated infection. Prior to this study, no research of this kind had been done at Ndola Teaching Hospital in Ndola, Zambia, to determine the prevalence of SSI after general surgery. This study therefore aimed at determining the burden and associated risk factors for surgical site infections in General Surgery Department of Ndola Teaching Hospital. Materials and Methods: A hospital-based retrospective descriptive study conducted Ndola Teaching Hospital general surgery dept. Selected and operated patients’ hospital records were reviewed. Pearson Chi-square test and Odds ratio were used to test for each risk factor’s association with SSI followed by their 95% confidence interval. Only p-value less than 0.05 was considered statistically significant. Results: The burden of surgical site infections was 18% [OR=0.394; 95%CI = (0.179-0.867)]. Factors that showed a significant association with the burden were gender [OR=3.394; 95%CI= (1.179-8.867), p=0.014], post-operative duration of hospital stay [OR=20.308; 95%CI= (3.364-27.798), p=0.00], emergency surgeries [OR=3.445; 95%CI = (1.625-7.304), p= 0.001] and intra-operative duration [OR=12.476; 95%CI= (4.104-37.925), p= 0.000]. However, there was no association observed between the qualification of the surgeon and the development of the infection. Conclusion: Surgical site infections were high and associated with the duration of hospital stay, intra-op duration of the procedure, the type of surgery and gender. It remains imperative to find possible interventions to reduce the risk of suffering from surgical site infections among patients who go to theatre.

The burden of surgical site infections in Australia: A cost-of-illness study

ObjectiveTo estimate the cost of surgical site infections in Australian public hospitals in 2018–19, to demonstrate the economic burden of hospital-associated infection in a well-resourced health system. MethodsA cost-of-illness analysis was conducted over a 1-year time horizon based on data from published literature extrapolated using simulation techniques. The direct and indirect costs of SSI were estimated for Australia and each of its states and territories. ResultsAn estimated 16,541 cases of SSI occurred in Australian public hospitals in 2018–19, resulting in a total direct cost of A$323.5 million. The average cost per case was A$18,814, which was 2.5 times the average per capita spending on health. The indirect costs of absenteeism and premature death were valued at A$23.0 million and A$2 948.1 million per annum, respectively. ConclusionSSI is a significant but preventable cost with most of the financial burden coming from premature deaths but underreporting means our costs are likely underestimated.

The Burden of Surgical Site Infection at Hospital Universiti Sains Malaysia and Related Postoperative Outcomes: A Prospective Surveillance Study

Surgical site infections (SSIs) are the most common healthcare-associated infections that occur among surgical patients. Surgical site infections result in longer hospital stays, hospital readmissions, and higher death and morbidity rates. The current study was designed to highlight the importance of such surveillance studies in a Malaysian surgical population with a motive to evaluate and revise concurrent infection control and prevention policies by exploring the burden of surgical site infection and identifying its associated risk factors for future considerations. In this prospective observational cohort study, a total of 216 patients admitted to a surgical ward were identified and studied. Of these 216 patients, 142 elective procedures and 74 emergency procedures were included in the study, of which 13 patients (9.2%) undergoing elective procedures and 15 (20.3%) patients undergoing emergency procedures were SSI positive (OR: 2.5, p = 0.02). Among surgical site infections, 21 were superficial and 7 were deep incisional SSI. No case of organ/space SSI was identified. The time taken for SSIs to develop ranged from 2-17 days with a median of 6 days. Risk factors such as presence of comorbidities (p = 0.011), major co-existing medical diagnosis ≥2 (p = 0.02), and pre-existing infection (p = 0.027) were statistically significant. SSI-positive patients experienced an increase in the post-operative length of hospital stay. In the current population, it was seen that identifying patients who were at high risk of malnutrition via MUST and the NNIS risk index will help clinicians in identifying high risk patients and in managing their patients appropriately. Identifying patients who were at high risk of malnutrition will also improve postoperative outcomes considerably.

Overview of Rate and Risk Factors of Surgical Site Infection in a Tertiary Hospital in Liberia: A Prospective Cohort Study.

Surgical site infection (SSI) is accountable for a third of postoperative deaths and for 8% of all deaths due to hospital-acquired infections. There is a wide disparity in the incidence and burden of SSI in low and high-income countries. To assess the rates and risk factors of SSI in a tertiary hospital in a resource-limited sub-Saharan African country and generate institutional baseline data for future monitoring and interventions. This was a descriptive prospective cohort study done at John F Kennedy Memorial Hospital, a tertiary hospital in Monrovia, Liberia, from October 18 to December 18, 2021. Consecutive participants, including children and adults that had surgical operations within the study period, were recruited. Criteria for diagnosis of SSI were as defined by the Centre for Disease Control (1999). Data were collected on the demography of the participants, type of surgery done, presence of SSI, comorbidities, and risk factors for SSI. Of the 111 patients analyzed, thirty-two patients had SSI giving a hospital incident rate of 28.8%. This comprises superficial SSI (22/31; 71.0%), deep SSI (6/31; 19.4%), and organ/space SSI (3/31; 9.7%). Twelve out of 42 females (28.6%) and 20 of 69 males (29.0%) had SSI. There is no statistically significant difference in gender SSI rate (P = 0.963). SSI occurred more in dirty wounds (13/23; 56.5%), compared to contaminated wounds (6/11, 54.6%), clean contaminated (7/22; 31.8%), and clean wounds (6/55, 10.9%). There is a statistical difference in the rate of SSI among the wound classes (P = 0.001). The infection rate is also more in emergency surgeries (18/39, 46.2%) compared to elective surgeries (14/72, 19.4%), and it is significant (P = 0.003). Statistically, there was no significant difference between the two skin preparation agents used (P = 0.351). The abdomen was the most common site of surgical incision and had the highest rate of SSI (24/79; 30.4%) (P = 0.045). There was no statistical difference in SSI rate between those whose hairs were removed in the ward or in the theatre (P = 0.114); length of incision (P = 0.297), or duration of surgery (P = 0.715) (see table for classification and rates). The SSI rate in our study is high at 28.8%. Abdominal surgeries, emergencies, and wound class accounted for the majority of the SSIs. The baseline data will be useful in developing infection control strategies.

Adapting infection prevention and control assessment tools for use in low- and middle-income countries

Background: There are many existing infection prevention and control (IPC) tools developed and validated by large organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention. These tools are generally created with little input from professionals working in low-income regions and are tested in high-income countries and/or high-level facilities in low- and middle-income countries (LMICs). Recent publications have highlighted both the disproportionate burden of surgical site infections (SSIs) in LMICs and the very limited data on surgical conditions and practices in these regions. There is a need and a desire for quality improvement in SSI/IPC/patient safety in low-level facilities in LMIC. Therefore, a logical starting point would be to adapt available tools for use in resource-limited facilities, with a strong focus on input and enthusiastic participation from local health-care workers and leadership. Our goal was to assess IPC capacity of facilities by analyzing health-care-associated infection (HAI) surveillance, hospital workforce and infrastructure, environmental cleaning, and surgical operative practices. Methods: We created an adapted survey using components from the WHO’s Guideline on Core Components for IPC and Essential Surgical Care Situational Analysis Tool that addressed IPC program support, HAI surveillance, surgical preparation practices, and infrastructural support. Purposive sampling was used to identify 23 health facilities across 7 counties in Kenya. We chose to use cesarean section as a bellwether procedure because it is a high-volume procedure in LMIC. Permission to conduct the survey was solicited from facility leadership prior to the beginning of the survey. Two surveyors visited each facility to complete the adapted assessment framework. Results: All facilities had an IPC program and 22 (95.6%) reported that their program was supported by facility leadership and a professional IPC team. However, only 10 (43.5%) facilities reported a specific IPC budget. Eight (34.8%) facilities had on-site and 8 (34.8%) had off-site microbiological laboratory. Twelve (52.2%) conducted HAI surveillance, and out of those that conducted HAI surveillance, 11 (91.7%) monitored specifically for SSIs. Most had adequate and reliable water (95.6%) and power (91.3%). Fifteen (65.2%) allowed bed-sharing and 6 (26.1%) placed beds in hallways or areas other than rooms. Over 75% of facilities did not follow the WHO-recommended preoperative practices on bathing, hair removal, and skin preparation. Conclusions: This survey was a time and resource-efficient way of collecting the data needed to understand the variables associated with surgery, SSI, and IPC in low-level facilities. Clear targets for surgical practice improvement were identified, and the workforce and infrastructure data will be used to design effective and sustainable solutions.

Clinical and economic burden of surgical site infections in inpatient care in Germany: A retrospective, cross-sectional analysis from 79 hospitals.

Surgical site infections (SSI) present a substantial burden to patients and healthcare systems. This study aimed to elucidate the prevalence of SSIs in German hospitals and to quantify their clinical and economic burden based on German hospital reimbursement data (G-DRG). This retrospective, cross-sectional study used a 2010-2016 G-DRG dataset to determine the prevalence of SSIs in hospital, using ICD-10-GM codes, after surgical procedures. The captured economic and clinical outcomes were used to quantify and compare resource use, reimbursement and clinical parameters for patients who had or did not have an SSI. Of the 4,830,083 patients from 79 hospitals, 221,113 were eligible. The overall SSI prevalence for the study period was 4.9%. After propensity-score matching, procedure type, immunosuppression and BMI ≥30 were found to significantly affect the risk of SSI (p<0.001). Mortality and length of stay (LOS) were significantly higher in patients who had an SSI (mortality: 9.3% compared with 4.5% [p<0.001]; LOS (median [interquartile range, IQR]): 28 [27] days compared with 12 [8] days [p<0.001]). Case costs were significantly higher for the SSI group (median [IQR]) €19,008 [25,162] compared with € 9,040 [7,376] [p<0.001]). A median underfunding of SSI was identified at €1,534 per patient. The dataset offers robust information about the "real-world" clinical and economic burden of SSI in hospitals in Germany. The significantly increased mortality of patients with SSI, and their underfunding, calls for a maximization of efforts to prevent SSI through the use of evidence-based SSI-reduction care bundles.

Role of single-ring oval disposable wound protecting device in preventing surgical site infection in laparoscopic colorectal resections.

Surgical site infections (SSI) continue to be a major cause of morbidity, mortality, prolonged hospital stays and a major reason of financial burden to health-care providers and patients after major abdominal surgeries. Along with infection control practices and care bundles, additional use of devices which protect the wound from contamination is believed to decrease the burden of SSI. This study aims to assess the benefit of single-ring disposable wound protector in preventing SSI, overall complications, hospitals stay and morbidity data in laparoscopic colorectal resection. The study design involves case-control study, retrospective. A case-control study comparing single ring oval wound protector versus conventional wound protectors retrospectively between August 2019 and December 2021. The ease of use of the device, rate of SSI, overall complications, hospitals stay and morbidity data were analysed. The statistical analysis was performed by IBM SPSS Statistics 20 version. All Categorical Variables will be described as frequency and percentage. Continuous variables will be described as mean ± standard deviation. Continuous variables were analysed using t-test and categorical parameters using Fisher's exact test. Of the 110 patients studied, wound Protecting devices were used in 58 patients Wound Protector Group (WPG group) and 62 patients did not use such devices (no WPG). The groups were comparable in demographic features, risk features, systemic illness, type of surgeries undertaken and the specimen extraction wound used. There was a significant decrease in the incidence of SSI (1.7% vs. 16% P ≤ 0.008) and the hospital stay (P ≤ 0.03) when WPG was used compared to the group in which it was not used. Apart from the use of infection control practices and care bundles, the use of oval-shaped single-ring wound protector is likely to reduce SSI.

A study of clinical and economic burden of surgical site infection in patients undergoing caesarian section at a tertiary care teaching hospital in India.

BackgroundCaesarian section is one of the most commonly performed surgeries in India. Determination of the incidence as well as the clinical and financial burden of post caesarian surgical site infection (SSI), is of critical importance for all the stakeholders for rational and fair allocation of resources.MethodsThis study was a prospective observational case-control study. The mean direct and indirect cost of treatment for the cases were compared with the control patients. An unpaired t-test was used to compare the mean between the two groups.ResultsOut of 2024 patients, who underwent caesarian section during the study period, 114 had acquired incisional surgical site infection (ISSI), with the infection incidence being 5.63%. The total cost of illness due to post caesarian ISSI was almost three times higher compared to the non-infected matched control group. (P<0.0001). An average length of hospital stay in the ISSI patient group was 10 days longer than that in the control group (P<0.0001) and importantly total length of antimicrobial therapy(LOT) in patients with ISSI was also almost three times higher than the control group (P<0.0001).ConclusionThe development of post caesarian SSI imposes a significant clinical as well as a financial burden. The study highlights the necessity of taking effective preventive measures to decrease the incidence of SSI.

Risk and economic burden of surgical site infection following spinal fusion in adults.

Spinal fusion surgery (SFS) is one of the most common operations in the United States, >450,000 SFSs are performed annually, incurring annual costs >$10 billion. We used a nationwide longitudinal database to accurately assess incidence and payments associated with management of postoperative infection following SFS. We conducted a retrospective, observational cohort analysis of 210,019 patients undergoing SFS from 2014 to 2018 using IBM MarketScan commercial and Medicaid-Medicare databases. We assessed rates of superficial/deep incisional SSIs, from 3 to 180 days after surgery using Cox proportional hazard regression models. To evaluate adjusted payments for patients with/without SSIs, adjusted for inflation to 2019 Consumer Price Index, we used generalized linear regression models with log-link and γ distribution. Overall, 6.6% of patients experienced an SSI, 1.7% superficial SSIs and 4.9% deep-incisional SSIs, with a median of 44 days to presentation for superficial SSIs and 28 days for deep-incisional SSIs. Selective risk factors included surgical approach, admission type, payer, and higher comorbidity score. Postoperative incremental commercial payments for patients with superficial SSI were $20,800 at 6 months, $26,937 at 12 months, and $32,821 at 24 months; incremental payments for patients with deep-incisional SSI were $59,766 at 6 months, $74,875 at 12 months, and $93,741 at 24 months. Corresponding incremental Medicare payments for patients with superficial incisional at 6, 12, 24-months were $11,044, $17,967, and $24,096; while payments for patients with deep-infection were: $48,662, $53,757, and $73,803 at 6, 12, 24-months. We identified a 4.9% rate of deep infection following SFS, with substantial payer burden. The findings suggest that the implementation of robust evidence-based surgical-care bundles to mitigate postoperative SFS infection is warranted.

The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study.

Despite the prolongation of hospitalization, increase in morbidity, mortality and cost of care associated with both surgical site infections (SSIs) and antibiotic resistance, there are limited data on SSIs and antibiotic resistance to guide prevention strategies in Sierra Leone. This study assessed the burden of SSIs and related antibiotic resistance in the 34 Military Hospital (MH) and Makeni Government Hospital (MGH) located in two geographic regions of Sierra Leone using a prospective study design to collect data from adults aged 18 years or older. Of the 417 patients, 233 (55.9%) were enrolled in MGH. Most were women 294 (70.5%). The incidence rate of SSI was 5.5 per 1000 patient-days, and the cumulative incidence of SSI was 8.2%. Common bacteria isolated in MH were Escherichia coli (6,33.3%) and Pseudomonas aeruginosa (3,16.7%) and in MGH were P. aeruginosa (3,42.9%) and Proteus mirabilis (2,28.9%). Of the gram-negative bacteria, 40% were Extended-spectrum beta-lactamase-producing Enterobacteriaceae, 33% were Carbapenem-resistant P. aeruginosa and 10% were carbapenem-resistant Enterobacteriaceae. Although the incidence of SSIs in our study is lower than previously reported, the rate of antibiotic resistance reported in this study is high. Urgent action is needed to invest in the microbiology infrastructure to support SSI surveillance and prevention strategies.

Assessment of risk and economic burden of surgical site infection (SSI) posthysterectomy using a U.S. longitudinal database

BackgroundSurgical site infection posthysterectomy has significant impact on patient morbidity, mortality, and health care costs. This study evaluates incidence, risk factors, and total payer costs of surgical site infection after hysterectomy in commercial, Medicare, and Medicaid populations using a nationwide claims database. MethodsIBM MarketScan databases identified women having hysterectomy between 2014 and 2018. Deep-incisional/organ space (DI/OS) and superficial infections were identified over 6 months postoperatively with risk factors and direct infection-associated payments by insurance type over a 24-month postoperative period. ResultsAnalysis identified 141,869 women; 7.8% Medicaid, 5.8% Medicare, and 3.9% commercially insured women developed deep-incisional/organ space surgical site infection, whereas 3.9% Medicaid, 3.2% Medicare, and 2.1% commercially insured women developed superficial infection within 6 months of index procedure. Deep-incisional/organ space risk factors were open approach (hazard ratio, 1.6; 95% confidence interval, 1.5–1.8) and payer type (Medicaid versus commercial [hazard ratio, 1.4; 95% confidence interval, 1.3–1.5]); superficial risk factors were payer type (Medicaid versus commercial [hazard ratio, 1.4; 95% confidence interval, 1.3–1.6]) and solid tumor without metastasis (hazard ratio, 1.4; 95% confidence interval, 1.3–1.6). Highest payments occurred with Medicare ($44,436, 95% confidence interval: $33,967–$56,422) followed by commercial ($27,140, 95% confidence interval: $25,990–$28,317) and Medicaid patients ($17,265, 95% confidence interval: $15,247–$19,426) for deep-incisional/organ space infection at 24-month posthysterectomy. ConclusionsReal-world cost of managing superficial, deep-incisional/organ space infection after hysterectomy was significantly higher than previously reported. Surgical approach, payer type, and comorbid risk factors contributed to increased risk of infection and economic burden. Medicaid patients experienced the highest risk of infection, followed by Medicare patients. The study suggests adoption of a robust evidence-based surgical care bundle to mitigate risk of surgical site infection and economic burden is warranted.