Economic case for intraoperative interventions to prevent surgical-site infection

Gillespie, Brigid M.; Chaboyer, Wendy; Erichsen-Andersson, Annette; Hettiarachchi, Ruvini; Kularatna, Sanjeewa

doi:10.1002/bjs.10428

Cited by 19 publications

(16 citation statements)

References 41 publications

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“…The implementations of surgical site reduction bundles, however, are also not without a financial impact on participating institutions. In a 2017 Australian meta-analysis of more than 1,200 studies on cost effectiveness of SSI reduction interventions, a mere 5 articles were considered suitable for review, and of these, only 2 were categorized as “high quality” studies [3]. All 5, notably, did find some measure of cost effectiveness in the use of various SSI reduction interventions (specifically in wound dressings).…”

Section: Discussionmentioning

confidence: 99%

“…For those undergoing inpatient surgery, the rate of SSIs is 2–5% [2]. SSIs are associated with an increased length of hospital stay, readmission rates, hospitalization costs, and overall mortality [3]. A 2015 ACS National Surgical Quality Improvement Program (NSQIP) analysis showed that the most common reason for unplanned postoperative readmission was general SSIs (19.5%) [4].…”

Section: Introductionmentioning

confidence: 99%

“…SSIs are associated with an increased length of hospital stay of approximately 10 days and increased hospital costs of approximately $20,000 per admission [1]. The indirect costs of SSIs, such as loss of productivity for patients and families are more difficult to quantify [3]. Overall, the estimated cost of SSIs is $3.5–10 billion per year in the United States [1].…”

Section: Introductionmentioning

confidence: 99%

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Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Schiavone

Moukarzel

Leong

et al. 2017

Gynecologic Oncology

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Objective Surgical site infections (SSIs) can lead to substantial morbidity, prolonged hospitalization, increased costs, and death in patients undergoing colorectal procedures. We sought to investigate the effect of using an SSI reduction bundle on the rate of SSIs in gynecologic cancer patients undergoing colon surgery. Methods We identified all gynecologic cancer patients who underwent colon resection at our institution from 2014–2016, during which time a service-wide SSI reduction bundle was introduced. The intervention included preoperative oral antibiotics with optional mechanical bowel preparation, skin preparation with antibacterial solution, and the use of a separate surgical closing tray. SSI rates were assessed within 30 days post-surgery. Results Of 233 identified patients, 115 had undergone colon surgery prior to (PRE) and 118 after (POST) the implementation of the intervention. A low anterior resection was the most common colon surgery in both cohorts. The incidence of SSI within 30 days of surgery was 43/115 (37%) in the PRE and 14/118 (12%) in the POST cohorts (p≤0.001). Wound dehiscence was noted in 30/115 (26%) and 2/118 (2%) patients, respectively (p≤0.001). In patients whose operation took longer than 360 minutes, 30-day SSI rates were 37% (28/76) and 12% (8/67), respectively (p≤0.001). In patients with an estimated blood loss >500 cc, SSI rates were 44% (27/62) and 15% (10/67), respectively (p≤0.001). Conclusions The implementation of an SSI reduction bundle was associated with a significant reduction in 30-day SSIs in these patients. The intervention remained effective in patients undergoing longer operations and in those with increased blood loss.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Schiavone

Moukarzel

Leong

et al. 2017

Gynecologic Oncology

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“…Several systematic reviews have reported on aseptic skin preparation (including surgical hand asepsis, intraoperative skin antisepsis and skin preparation with chlorhexidine), dressings including wound edge protection devices , increased oxygen supplementation, glucose control and thermoregulation. Two reviews have reported on the cost‐effectiveness of the interventions and the quality of health economic reporting.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of the cost-effectiveness of preoperative antibiotic prophylaxis in reducing surgical-site infection

2018

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BackgroundSurgical‐site infections (SSIs) increase the length of hospital admission and costs. SSI prevention guidelines include preoperative antibiotic prophylaxis. This review assessed the reporting quality and cost‐effectiveness of preoperative antibiotics used to prevent SSI.MethodsPubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Index of Economic Articles (EconLit), Database of Abstracts of Reviews of Effect (including the National Health Service Economic Evaluation Database) and Cochrane Central databases were searched systematically from 1970 to 2017 for articles that included costs, preoperative antibiotic prophylaxis and SSI. Included were RCTs and quasi‐experimental studies conducted in Organisation for Economic Co‐operation and Development countries with participants aged at least 18 years and published in English. Two reviewers assessed eligibility, with inter‐rater reliability determined by Cohen's κ statistic. The Consolidated Health Economic Evaluation and Reporting Standards (CHEERS) and modified Drummond checklists were used to assess reporting and economic quality. Study outcomes and characteristics were extracted, and incremental cost‐effectiveness ratios were calculated, with costs adjusted to euros (2016) (€1 = US $1·25; £1 sterling = €1·28).ResultsTwelve studies published between 1988 and 2014 were included from 646 records identified; nine were RCTs, two were nested within RCTs and one was a retrospective chart review. Study quality was highest in the nested studies. Cephalosporins (first, second and third generation) were the most frequent prophylactic interventions. Eleven studies demonstrated clinically effective interventions; ten were cost‐effective (the intervention was dominant); in one the intervention was dominated by the control; and in one the intervention was more effective and more expensive than the control.ConclusionPreoperative antibiotic prophylaxis does reduce SSI, costs to hospitals and health providers, but the reporting of economic methods in RCTs is not standardized. Routinely nesting economic methods in RCTs would improve economic evaluations and ensure appropriate selection of prophylactic antibiotics.

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“…There remain significant evidence gaps in the prevention of SSI, highlighted by the four research recommendations made in this guideline. In order to inform policy in LMICs, it is essential that future trials incorporate health economic evaluation.…”

Section: Discussionmentioning

confidence: 99%

Delphi prioritization and development of global surgery guidelines for the prevention of surgical-site infection

Adenekan¹,

Cotton²,

Davies³

et al. 2020

British Journal of Surgery

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Background Most clinical guidelines are developed by high‐income country institutions with little consideration given to either the evidence base for interventions in low‐ and middle‐income countries (LMICs), or the specific challenges LMIC health systems may face in implementing recommendations. The aim of this study was to prioritize topics for future global surgery guidelines and then to develop a guideline for the top ranked topic. Methods A Delphi exercise identified and prioritized topics for guideline development. Once the top priority topic had been identified, relevant existing guidelines were identified and their recommendations were extracted. Recommendations were shortlisted if they were supported by at least two separate guidelines. Following two voting rounds, the final recommendations were agreed by an international guideline panel. The final recommendations were stratified by the guideline panel as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack these resources at present, in which case they should plan for future implementation). Results Prevention of surgical‐site infection (SSI) after abdominal surgery was identified as the highest priority topic for guideline development. The international guideline panel reached consensus on nine essential clinical recommendations for prevention of SSI. These included recommendations concerning preoperative body wash, use of prophylactic antibiotics, decontamination of scrub teams' hands, use of antiseptic solutions for surgical site preparation and perioperative supplemental oxygenation. In addition, three desirable clinical recommendations and four recommendations for future research were agreed. Conclusion This process led to the development of a global surgery guideline for the prevention of SSI that is both clinically relevant and implementable in LMICs.

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Economic case for intraoperative interventions to prevent surgical-site infection

Cited by 19 publications

References 41 publications

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Systematic review of the cost-effectiveness of preoperative antibiotic prophylaxis in reducing surgical-site infection

Delphi prioritization and development of global surgery guidelines for the prevention of surgical-site infection

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