Surgical Site Infection: The Clinical and Economic Impact

Abstract

Surgical site infection (SSI) following colorectal surgery is associated with worse postoperative outcomes, longer length of stay, and higher rates of readmission. SSI rates have been established as a surrogate metric for the overall quality of surgical care and are intricately tied to financial incentives and the public reputation of an institution. While risk factors and prevention mechanisms for SSI are well established, the rates of SSI remain high. This article discusses the clinical and economic impact of SSI and strategies for mitigating the risk of SSI through bundled prevention practices.

Adherence to a standardized infection reduction bundle decreases surgical site infections after colon surgery: a retrospective cohort study on 526 patients

“…Prior studies implementing Colon Bundles have shown a significant reduction in superficial SSI rates from 57 to 70 %, but mixed effects on deep SSI rates [ 4 , 5 ]. Though some studies show a 70 % reduction in deep SSI rates [ 9 ], others show no effect [ 4 ]. Our Colon Bundle implementation shows that meaningful reduction in deep organ space infections is achievable.…”

“…Not only do SSIs prolong hospital length of stay and hospital costs [ 3 ], but they are also associated with an increased risk of death [ 1 ]. It has been shown that implementing colon bundles effectively reduce SSIs, however, such bundles are still not universally employed and there are varying elements included in the different bundles [ 4 – 6 ].…”

Immunonutrition in Patients with Colon Cancer

“…Aside from the aforementioned adverse effects on clinical outcome, high infectious complication is linked with significant negative economic consequences. In fact, it is estimated that the USA spends more than $3 billion annually on SSIs [15]. Following the evidence related to immunonutrition with lower infectious complications, several studies have evaluated the cost-effectiveness of immunonutrition, comparing the cost and clinical effect versus conventional treatment (nonimmunonutrition).…”

“…In fact, colorectal surgery patients are disproportionately affected by SSI, with rates of up to 25%. Naturally, this is related to the clean-contaminated nature of many colorectal procedures, as well as exteriorization of the bowel; however, up to 55% of these infections have been deemed preventable [15].…”

Diagnosis of colorectal and emergency surgical site infections in the era of enhanced recovery: an all‐Wales prospective study

“…SSIs have a significant impact, not only on morbidity and mortality but also on a patient's experience of recovery following an operation [6]. SSIs present a significant financial burden both to the healthcare system, through extra inpatient bed days and the costs of additional primary and secondary care services, and to the patient, in terms of lost work days and travel to appointments, with a resultant economic impact for wider society [2,7].…”