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23 janvier, 2008 14:49

ST. LOUIS, Jan. 22 -- Surgical site infections after breast procedures added more than $4,091 to the cost after adjusting for a number of variables, researchers here said.

Unadjusted median cost for patients with such infections was $16,882 compared with $6,123 for patients who did not develop an infection, according to Margaret Olsen, Ph.D., and colleagues at Washington University School of Medicine and Barnes-Jewish Hospital.

Surgical site infection also led to a median increase of 4.3 days in the total length of time in the hospital, the researchers reported in the January issue of Archives of Surgery.

The findings suggest a need for interventions to reduce the incidence of infection, the researchers said.

Potential interventions "include strategies to optimize the timing and dosage of prophylactic antibiotics administered before the surgical incision, glucose control in diabetic patients, promotion of meticulous hand hygiene, and strategies to promote timely removal of drains," they said.

The findings come from a retrospective analysis of patient and accounting records at Barnes-Jewish from July 1, 1999 through June 30, 2002 and include all patients who had breast surgery -- other than breast-conserving surgery for cancer -- during that two-year period.

Patients who had a lumpectomy were excluded, Dr. Olsen and colleagues said, because surgical site infections were rarely seen in that population.

All told, the researchers found 949 patients who were treated with mastectomy or breast reconstruction during the two-year period. Because some had multiple admissions, the final cohort was 888, including 40 men surgically treated for gynecomastia or malignancy.

Surgical site infections were identified using ICD-9 codes and were considered to be related to the surgery if they occurred within a year of the procedure, the researchers said.

Of the 50 cases of surgical site infection -- 5.3% of the cohort -- 96% were identified at readmission to the hospital. The median time to diagnosis of the infection was 25 days.

The incidence of surgical site infections, by procedure, was:

• 12.4% following mastectomy with immediate implant reconstruction
• 6.2% following mastectomy with immediate reconstruction using a transverse rectus abdominis myocutaneous (TRAM) flap
• 4.4% following mastectomy only
• 1.1% following breast reduction surgery

The more than $10,000 increase in mean costs seen with surgical site infections was adjusted for a range of factors such as the site itself, the type of reconstruction, and the presence of such co-morbidities as diabetes, cancer, or renal failure, bringing the cost attributable to infection to $4,091.

Patients with an infection also had a median length of stay of 6.3 days, compared with 2.0 for non-infected members of the cohort, the researchers found.

Dr. Olsen and colleagues noted that the figure of $4,091 accounts only for hospital-associated costs and leaves out such things as physician costs, outpatient antibiotic use, outpatient procedures, and home health care.

The "costs we calculated represent, at best, the minimum costs" associated with site infections after breast surgery, they said.

Primary source: Archives of Surgery
Source reference:
Olsen MA, et al "Hospital-associated costs due to surgical site infection after breast surgery" Arch Surg 2008; 143: 53-60.