M. E. Garstka1, Z. Al-Qurayshi1, S. M. Baker1, C. Ducoin1, M. Killackey1, E. Kandil1 1Tulane University School Of Medicine,Department Of Surgery,New Orleans, LA, USA
Introduction:
Postoperative infection (POI) represents a serious complication in all surgical disciplines and can undermine a patient’s treatment and recovery course. In this analysis, we aim to examine recent national trends in distribution, risk factors, and clinical burden of disease due to POI.
Methods:
We performed a cross-sectional study utilizing the Nationwide Inpatient Sample, 2003-2010. The study population consisted of adult (≥18 years) inpatients with POI. Controls were randomly selected from patients who underwent the same procedures. As the NIS represents 20% of US hospital admissions and includes costs, excess cost and excess stay was calculated based on the average difference between cases and controls and multiplied by five to estimate national burden. Cost was adjusted for inflation rate to reflect 2015 dollar value.
Results:
139,652 cases of POI and 941,670 controls were included. POIs were most common in procedures that involved the digestive tract (46.5%), cardiovascular system (16.3%), and musculoskeletal system (11.2%). In the sample, there was no significant change in the POI annual incidence (average: 17,456.5 case/year) (p=0.10). Older age, male, overweight, elective admission, and teaching or urban or large size hospitals all were independent risk factors of POI in the multivariate model (p<0.05). There was no significant risk difference based on trauma status (p=0.88). POI was associated with a higher mortality risk [OR: 2.93, 95%CI: (2.82, 3.04), p<0.001]. Nationally, it is estimated that POI resulted in an annual average of 1.04 million days of excess hospital stay and $2.72 billion excess cost.
Conclusion:
Demographic and clinical factors influence the risk of POI. These factors may suggest areas for clinical quality improvement initiatives, given such independent risk factors as elective admission and teaching, urban, or large size hospitals. POI poses substantial clinical and financial burden in the United States, and further analysis of the associated costs is also needed to identify areas for intervention to reduce this burden.
