Are we really seeing the total costs of surgical site infections? A Spanish study

Abstract

To identify overall costs generated by surgical site infections (SSI) patients, including indirect costs. A prospective study of case series of patients who have undergone major surgical treatment was undertaken. Patients who suffered SSI were compared with controls (nested case–control design). Centers for Disease Control and Prevention definitions were followed and SSI established. Overall costs and indirect related morbidity/mortality costs were estimated. The study was performed in a general, tertiary hospital (Valencia, Spain) for 4.5 years. Surgical site infections patients were 9.02% of the total people who underwent surgery. Their stays were prolonging by 14 days, and resources were used more intensely and for longer periods than in controls. Excess hospital costs were $10,232 per patient of which 37% corresponded to prolonged stays. Health costs only accounted for 10% of overall costs; $97,433 per patient including indirect social costs. Studies merely assessing excess costs due to prolonged stays of SSI patients do not reflect the entire scenario as they simply represent 35% of real hospital costs. A comprehensive appraisal shows that total healthcare expenditures represent a tenth of overall costs, which strengthens the claims that investment in preventing SSI would be highly cost-effective.