WHAT IS THE VALUE OF PREVENTING POSTOPERATIVE INFECTIONS

The importance of postoperative infections depends on the frequency wi th which infection occurs as well as on the additional cost per patien t with infection. For example, in our hospital the additional cost per patient with infection after hernia repair was $600, compared with $2 ,106 per patient with infection after colonic surgery. However, the to tal excess cost per year was similar for hernia surgery ($44,800) and colon surgery ($48,440). The reason is that hernia surgery is much mor e common than colon surgery. It is a general principle of clinical aud it that the importance of problems should be defined by their frequenc y as well as their individual severity. A third important consideratio n is the Likelihood that the problem can be corrected. Undue attention has been given to the health resource costs of postoperative infectio n at the expense of information about the intangible costs to the pati ent (these are nonfinancial costs such as pain and disability), Health resource costs are very dependent on medical practice variation, and comparative studies between countries reveal marked differences in the way that apparently similar infections are managed. Moreover, compreh ensive audit of infection-control management often reveals wasteful pr actice, e.g, antibiotic treatment of patients who do not in fact have infection. Audit of postoperative infection should focus on eliminatin g wasteful practice (e.g., prophylactic antibiotics continuing > 24 hr s after surgery) as well as on reducing postoperative infection rates.