The Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections.

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES
Sonali Shambhu, Aliza S Gordon, Ying Liu, Maximilian Pany, William V Padula, Peter J Pronovost, Eugene Hsu
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引用次数: 0

Abstract

Objective: To assess the additional health care utilization, cost, and mortality resulting from three surgical site infections (SSIs): mediastinitis/SSI after coronary artery bypass graft, SSI after bariatric surgery for obesity, and SSI after certain orthopedic procedures.

Methods: This retrospective observational cohort study used commercial and Medicare Advantage/Supplement claims from 2016 to 2021. Patients with one of three SSIs were compared to a 1:1 propensity score-matched group of patients with the same surgeries but without SSI on outcomes up to one year postdischarge.

Results: The total sample size was 4,620. Compared to their matched cohorts, the three SSI cohorts had longer mean index inpatient length of stay (LOS; adjusted days difference ranged from 1.73 to 6.27 days, all p < 0.001) and higher 30-day readmission rates (adjusted odds ratio ranged from 2.83 to 25.07, all p ≤ 0.001). The SSI cohort for orthopedic procedures had higher 12-month mortality (hazard ratio 1.56, p = 0.01), though other cohorts did not have significant differences. Total medical costs were higher in all three SSI cohorts vs. matched comparison cohorts for the index episode and 6 months and 1 year postdischarge. Average adjusted 1-year total medical cost differences ranged from $40,606 to $68,101 per person, depending on the cohort (p < 0.001), with out-of-pocket cost differences ranging from $330 to $860 (p < 0.05).

Conclusion: Patients with SSIs experienced higher LOS, readmission rates, and total medical costs, and higher mortality for some populations, compared to their matched comparison cohorts during the first year postdischarge. Identifying strategies to reduce SSIs is important both for patient outcomes and affordability of care.

与特定手术部位感染相关的医疗使用、成本和死亡率负担。
目的评估三种手术部位感染(SSI)导致的额外医疗利用率、成本和死亡率:冠状动脉旁路移植术后纵隔炎/SSI、肥胖症减肥手术后 SSI 以及某些矫形手术后 SSI:这项回顾性观察队列研究使用的是 2016 年至 2021 年的商业和医疗保险优势/补充报销单。将三种 SSI 之一的患者与 1:1 的倾向得分匹配组进行比较,该组患者接受了相同的手术,但出院后一年内未发生 SSI:样本总数为 4,620 人。与匹配队列相比,三个 SSI 队列的平均指标住院时间(LOS;调整后的天数差异从 1.73 天到 6.27 天不等,所有 p 均小于 0.001)更长,30 天再入院率更高(调整后的几率比从 2.83 到 25.07 不等,所有 p 均小于 0.001)。骨科手术 SSI 组群的 12 个月死亡率较高(危险比为 1.56,P = 0.01),但其他组群没有显著差异。与匹配的对比组群相比,所有三个 SSI 组群在发病、出院后 6 个月和 1 年的总医疗费用都更高。平均调整后的 1 年总医疗费用差异从每人 40,606 美元到 68,101 美元不等(视队列而定)(p < 0.001),自付费用差异从 330 美元到 860 美元不等(p < 0.05):结论:与匹配的对比队列相比,SSI 患者在出院后第一年的住院时间、再入院率和医疗总费用较高,部分人群的死亡率也较高。确定减少 SSI 的策略对于患者的治疗效果和医疗费用的可负担性都非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
4.30%
发文量
116
审稿时长
49 days
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