Financial Impact of Surgical Site Infection after Kidney Transplantation: Implications for Quality Improvement Initiative Design

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“…Delayed graft function is a manifestation of acute kidney injury, with attributes unique to the transplant process. [24][25][26] Delayed graft function is defined as the requirement of dialysis within 7 days after renal transplant. Delayed graft function after renal transplant adversely affects patient quality of life, and the requirement for dialysis and additional biopsy evaluation of the transplanted kidney prolong hospital stays.…”

“…[1][2][3][4][5][6][9][10][11][12][13][14][15][16][17] The average cost of initial hospitalization for patients undergoing deceased donor renal transplant, who develop DGF, is approximately $25 000 higher per patient. [17][18][19][20][24][25][26][27][28] When the clinical manifestations of DGF, such as increased rate of acute rejection and worse graft survival, are taken into account, the economic impact is expanded. 19,20,27 Delayed graft function is thus associated with lower graft survival, longer hospital stay, higher costs, and increased psychologic and significant medical sequelae.…”

“…19,20,27 Delayed graft function is thus associated with lower graft survival, longer hospital stay, higher costs, and increased psychologic and significant medical sequelae. [17][18][19][20][21][24][25][26][27][28][29][30] In patients with DGF, hemodialysis itself is an additional oxidative stress. The need for even 1 dialysis session posttransplant creates a milieu that affects B and T cells, which can lead to impaired wound healing and/or wound breakdown.…”

“…26 Older donors also have a greater association with DGF, in part because older kidneys react poorly to acute kidney injury. [24][25][26][27][28][29][30] The lower physiologic reserve tempers the ability to recover from insult. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]24,25,27,28 We did not see a correlation between incisional hernias and obesity.…”

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“…1,2 Meticulous analyses of early and recent reports have shown postoperative wound infection rates in renal trans plant recipients to vary from 2% to 40%, with most studies demonstrating a rate from 4% to 16%. [3][4][5][6][7][8][9][10] Despite this low rate of wound infection in renal transplant recipients, infectious wound complications, when combined with immunosuppression, can be devastating and pose a vexing medical, surgical, and economic problem. Medically, wound infections may put the survival of the patient or the renal allograft at risk, thus lengthening hospital stay and increasing cost, which could be a great financial burden to the patient or the social security services.…”