TOTAL AND ATTRIBUTABLE COSTS OF SURGICAL-WOUND INFECTIONS AT A CANADIAN TERTIARY-CARE CENTER

OBJECTIVE: To determine the total and attributable costs of surgical-w ound infections in a Canadian teaching hospital. DESIGN: Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluati on Protocol (AEP), a validated chart review instrument designed to det ermine appropriateness of care, modified for wound infections. SETTING : A university referral center in Canada. PATIENTS: Medical records we re abstracted from patients with wound infections who underwent an inp atient clean or clean-contaminated procedure during 1991. MEASUREMENTS : During the wound-infection treatment period, the hospital costs asso ciated with providing care were tabulated for all inpatient days and f or outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, opera ting room time, laboratory, pharmacy, supplies, ancillary tests, and h otel costs. RESULTS: We identified 108 wound infections. Twenty-two pa tients required 28 surgical procedures related to a wound infection. I npatient days totalled 1,116, costing $394,337. Fifty-five emergency a nd 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, mere directly att ributable to the wound infection. The hospital costs for inpatient car e attributable to wound infections were $321,533 in total, or $3,937 p er infection. Costs were distributed as follows: nursing, 51% hotel, 1 4%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6% ; professional services, 5%; operating room, 3%; and ancillary tests, 2%. CONCLUSIONS: Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily t o determine attributable days of care and costs of wound infections, w hich are necessary to calculate the cost-benefit of infection control programs(Infect Control Hosp Epidemiol 1998;19:254-259).