The impact of surgical-site infections in the 1990s: Attributable mortality, excess length of hospitalization, and extra costs

OBJECTIVE: To determine mortality, morbidity, and costs attributable to sur gical-site infections (SSIs) in the 1990s. DESIGN: A matched follow-up study of a cohort of patients with SSI, matched one-to-one with patients without SSI. SETTING: A 415-bed community hospital. STUDY POPULATION: 255 pairs of patients with and without SSI were matched o n age, procedure, National Nosocomial Infection Surveillance System risk in dex, date of surgery, and surgeon. OUTCOME MEASURES: Mortality, excess length of hospitalization, and extra di rect costs attributable to SSI; relative risk for intensive care unit (ICU) admission and for readmission to the hospital. RESULTS: Of the 255 pairs, 20 infected patients (7.8%) and 9 uninfected pat ients (3.5%) died during the postoperative hospitalization (relative risk [ RR], 2.2; 95% confidence interval [CI95], 1.1-4.5). Seventy-four infected p atients (29%) and 46 uninfected patients (18%) required ICU admission (RR, 1.6; CI95, 1.3-2.0). The median length of hospitalization was 11 days for i nfected patients and 6 days for uninfected patients. The extra hospital sta y attributable to SSI was 6.5 days (CI95, 5-8 days). The median direct cost s of hospitalization were $7,531 for infected patients and $3,844 for uninf ected patients. The excess direct costs attributable to SSI were $3,089 (CI 95, $2,139-$4,163). Among the 229 pairs who survived the initial hospitaliz ation, 94 infected patients (41%) and 17 uninfected patients (7%) required readmission to the hospital within 30 days of discharge (RR, 5.5; CI95, 4.0 -7.7). When the second hospitalization was included, the total excess hospi talization and direct costs attributable to SSI were 12 days and $5,038, re spectively. CONCLUSIONS: In the 1990s, patients who develop SSI have longer and costlie r hospitalizations than patients who do not develop such infections. They a re twice as likely to die, 60% more likely to spend time in an ICU, and mor e than five times more likely to be readmitted to the hospital. Programs th at reduce the incidence of SSI can substantially decrease morbidity and mor tality and reduce the economic burden for patients and hospitals.