The Impact of Surgical-Site Infections Following Orthopedic Surgery at a Community Hospital and a University Hospital Adverse Quality of Life, Excess Length of Stay, and Extra Cost

Infection Control and Hospital Epidemiology - Tập 23 Số 4 - Trang 183-189 - 2002
J D Whitehouse1, N. Deborah Friedman2, Kathryn B. Kirkland2, William J. Richardson2, Daniel J. Sexton2
1Department of Medicine Duke University Medical Center Durham, North Carolina 27710 USA
2Duke University Medical Center

Tóm tắt

Objective:To measure the impact of orthopedic surgical-site infections (SSIs) on quality of life, length of hospitalization, and cost.Design:A pairwise-matched (1:1) case-control study within a cohort.Setting:A tertiary-care university medical center and a community hospital.Patients:Cases of orthopedic SSIs were prospectively identified by infection control professionals. Matched controls were selected from the entire cohort of patients undergoing orthopedic surgery who did not have an SSI. Matching variables included type of surgical procedure, National Nosocomial Infections Surveillance risk index, age, date of surgery, and surgeon.Main Outcome Measures:Quality of life, duration of postoperative hospital stay, frequency of hospital readmission, overall direct medical costs, and mortality rate.Results:Fifty-nine SSIs were identified. Each orthopedic SSI accounted for a median of 1 extra day of stay during the initial hospitalization (P= .001) and a median of 14 extra days of hospitalization during the follow-up period (P= .0001). Patients with SSI required more rehospitalizations (median, 2 vs 1;P= .0001) and more total surgical procedures (median, 2 vs 1;P= .0001). The median total direct cost of hospitalizations per infected patient was $24,344, compared with $6,636 per uninfected patient (P= .0001). Mortality rates were similar for cases and controls. Quality of life was adversely affected for patients with SSI. The largest decrements in scores on the Medical Outcome Study Short Form 36 questionnaire were seen in the physical functioning and role-physical domains.Conclusions:Orthopedic SSIs prolong total hospital stays by a median of 2 weeks per patient, approximately double rehospitalization rates, and increase healthcare costs by more than 300%. Moreover, patients with orthopedic SSIs have substantially greater physical limitations and significant reductions in their health-related quality of life.

Từ khóa


Tài liệu tham khảo

10.1016/S0039-6109(16)42030-X

10.1097/00005650-199206000-00002

10.1002/art.1780280513

10.1097/00005650-199205001-00024

10.2307/30141291

10.1097/00005650-199303000-00006

10.1086/501572

10.1001/jama.1989.03430070055030

Bombardier, 1995, Comparison of a generic and disease-specific measure of pain and physical function after knee replacement surgery, Med Care, 33, AS131

Went, 1995, Recurrence of infection after revision of infected hip arthroplasties, J Bone Joint Surg, 77, 307, 10.1302/0301-620X.77B2.7706354

Calderone, 1996, Cost of medical care for postoperative spinal infections, Orthop Clin North Am, 27, 171, 10.1016/S0030-5898(20)32060-5

10.1086/501641

10.1016/0002-9343(91)90361-Z

Vegas, 1993, Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization, Eur J Epidemiol, 9, 504

10.2307/30147164

Calderone, 1996, Outcome assessment in spinal infections, Orthop Clin North Am, 27, 201, 10.1016/S0030-5898(20)32062-9

10.1097/00003086-199610000-00019

Sculco, 1995, The economic impact of infected joint arthroplasty, Orthopedics, 18, 871

Ware, 1993, SF-36 Health Survey: Manual and Interpretation Guide

10.1097/00005650-198706000-00003

10.1016/S0196-6553(05)80148-8

10.1016/S0883-5403(05)80069-5

10.1001/archinte.1978.03630370022013

10.1093/oxfordjournals.aje.a113988

10.1097/00005650-199205001-00025

10.1097/00003086-199610000-00031

Kiebzak, 1997, SF-36 General Health Status Survey to determine patient satisfaction at short-term follow-up after total hip and knee arthroplasty, J South Orthop Assoc, 6, 169

10.2307/30141291

1996, SSI Rates, by Operative Procedure and Risk Index Category, October 1986-July 1996

10.1097/00000658-197703000-00002

10.1097/00005650-198108000-00005

10.2307/30141958

Taylor, 1995, The effect of surgical wound infection on postoperative hospital stay, Can J Surg, 38, 149

10.1017/S0195941700015241

10.1002/art.1790080310

10.1056/NEJM199201303260501

Thông tin
Thông tin xuất bản

Infection Control and Hospital Epidemiology

Tập 23 Số 4

183-189

Thông tin tác giả