Costs Associated with Surgical Site Infections in VA Hospitals

Schweizer ML, Cullen J, Vaughan-Sarrazin MS. Costs Associated with Surgical Site Infections in VA Hospitals. Paper presented at: Infectious Diseases Society of America Annual Meeting; 2012 Oct 12; San Diego, CA.

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Objectives: Surgical site infections (SSIs) are potentially preventable complications, associated with excess morbidity and mortality. In particular, deep SSIs are associated with significantly increased length of stay and mortality. We aimed to determine the excess costs associated with total, deep, and superficial SSIs in VA hospitals nationwide. Additionally, we aimed to determine the excess costs of SSIs separately for high-volume surgical specialties. Methods: The FY2006 VHA Decision Support System and VA National Surgical Quality Improvement Program databases were used to measure incremental costs associated with SSIs. SSIs were determined by infection preventionists using Centers for Disease Control and Prevention definitions. Linear mixed effects models were used to evaluate costs associated with SSIs, controlling for patient risk factors (e.g., American Society of Anesthesiologists [ASA] class, comorbidities) and hospital-level variation in costs. Costs of the index hospitalization and subsequent 30-day readmissions were included. Separate analyses were performed for the five highest volume surgical specialties. Results: Among 50,348 VA surgery patients, 2,101 (4.2%) experienced a SSI. Overall, 1.1% of the cohort had a deep SSI and 3.1% had a superficial SSI. The mean unadjusted costs for a patient (1) without an SSI were $25,643 and (2) with an SSI were $40,412. The unadjusted cost due to SSI was $14,769 (95%CI: $12,890, $16,649). In the risk adjusted analyses, the relative costs were 1.34 times greater for patients with SSI, relative to patients without SSI (95%CI: 1.30, 1.38; difference = $7,022). Deep SSIs were associated with 1.61 times greater costs (95%CI: 1.53, 1.71; difference = $12,927) and superficial SSIs were associated with 1.22 times greater costs (95%CI: 1.17, 1.26; difference = $4,531). When stratified by surgical specialty, the greatest mean cost attributable to SSI was $11,631 among patients undergoing neurosurgery, followed by general surgery, urology, peripheral vascular surgery, and orthopedic patients. Conclusions: SSIs are very costly to the VA. Deep SSIs and SSIs among neurosurgery patients are associated with the highest risk-adjusted costs. Impact Statement: Current VA quality improvement programs have been successful in reducing both MRSA infections and poor surgical outcomes. A business case can be made to focus future quality improvement efforts on SSI prevention in order to reduce morbidity, mortality and costs.