Costs and Complications Associated with Surgical Infections
ABSTRACT & COMMENTARY
Synopsis: Surgical patients who became infected during hospitalization had increased in-hospital mortality rates, longer length of stay, and required additional professional care after discharge compared to noninfected patients.
Source: DiPiro JT, et. al. Infection in surgical patients: Effects on mortality, hospitalization, and post-discharge care. Am J Health-Syst Pharm 1998;55:777-781.
This study involved 90 nongovernment, non-specialty, teaching and nonteaching acute care hospitals with more than 100 beds. Over 288,906 patients were available in the database that included patients of all ages hospitalized between July and September of 1994. From that database, 12,384 patients who had undergone procedures likely to pose a moderate to high risk of infection were selected.
Of the 12,384 patients studied, 1479 (11.9%) had an infection during hospitalization. Infection rates ranged from 1.9% to 25.4%, depending on the procedure. The in-hospital mortality rate was 14.5% for infected patients vs. 1.8% for noninfected patients. Similarly, length of stay in infected patients (median, 14 days) was substantially greater than in noninfected patients (median, 4 days). About 24% of infected patients required additional professional care after discharge, compared with 7% of noninfected patients.
COMMENT BY THOMAS SCHLEIS, MS, RPH
Despite advancements in surgical techniques and the use of prophylactic antimicrobials, infections still occur and are responsible for increased complications, length of stay, morbidity, and health care costs. Not surprisingly, infections are most prevalent in patients undergoing moderate-to-high risk surgeries. Patients with the highest mortality were those undergoing cholecystectomy, colorectal, upper digestive tract, and laparotomy procedures. DiPiro and associates also noted that patients with surgical infections were less likely to be discharged home for self-care and more likely to require post-discharge care.
It is evident from this article that, in addition to the procedures implemented to reduce the potential for infection, such as infection-control procedures, prophylactic antimicrobials, and sterile surgical techniques, there is still considerable potential for further reductions in surgical infections. There needs to be a better understanding of the sources of contamination and ways to prevent it or better deal with it at the time of contamination. Obviously, the high-risk surgeries are inherently `dirty,' but once specific circumstances or procedures can be correlated with surgical infection, methods of prevention can be implemented. A consultant recently shared with me an evaluation in one hospital where a particular surgeon was felt to have an unusually high rate of post-surgical infections. Upon further evaluation, it was determined that the surgeon did indeed have a higher rate of infection in less complex surgeries than the other surgeons but, in fact, had a lower rate of infection when more complex surgeries were looked at. This emphasizes the need for careful data collection and analysis.
It is unfortunate that this article did not look at the prophylactic antimicrobials used to determine if certain antimicrobials were more effective than others in reducing infection. Certainly that is another area that would be worth examining.
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