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Royle R, Gillespie BM, Chaboyer W, Byrnes J, Nghiem S. The burden of surgical site infections in Australia: A cost-of-illness study. J Infect Public Health 2023; 16:792-798. [PMID: 36963144 DOI: 10.1016/j.jiph.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/04/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To estimate the cost of surgical site infections in Australian public hospitals in 2018-19, to demonstrate the economic burden of hospital-associated infection in a well-resourced health system. METHODS A cost-of-illness analysis was conducted over a 1-year time horizon based on data from published literature extrapolated using simulation techniques. The direct and indirect costs of SSI were estimated for Australia and each of its states and territories. RESULTS An estimated 16,541 cases of SSI occurred in Australian public hospitals in 2018-19, resulting in a total direct cost of A$323.5 million. The average cost per case was A$18,814, which was 2.5 times the average per capita spending on health. The indirect costs of absenteeism and premature death were valued at A$23.0 million and A$2 948.1 million per annum, respectively. CONCLUSION SSI is a significant but preventable cost with most of the financial burden coming from premature deaths but underreporting means our costs are likely underestimated.
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Affiliation(s)
- Ruth Royle
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Brigid M Gillespie
- NHMRC CRE in Wiser Wounds, MHIQ, Griffith University, Southport, Queensland, Australia.
| | - Wendy Chaboyer
- NHMRC CRE in Wiser Wounds, MHIQ, Griffith University, Southport, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
| | - Son Nghiem
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia; Department of Health Economics, Wellbeing and Society, University Drive, Australian National University, ACT 0200, Australia
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2
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Sáenz A, Badaloni E, Grijalba M, Villalonga JF, Argañaraz R, Mantese B. Risk factors for surgical site infection in pediatric posterior fossa tumors. Childs Nerv Syst 2021; 37:3049-3056. [PMID: 34142227 DOI: 10.1007/s00381-021-05256-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Posterior fossa tumors are the most frequent pediatric solid tumor. Its main treatment is a surgical resection. Being a frequent procedure does not mean that it is exempt from complications, such as surgical site infections (SSI). The main objective of this paper is to study the risk factors associated with SSI following a resection of posterior fossa tumors in a purely pediatric population. METHODS A retrospective case-control study including all posterior fossa tumor surgeries performed at our hospital between January 2014 and December 2019 was conducted. All patients with a diagnosis of a postoperative SSI have been included as cases, and those who had surgery and no infectious complications have been considered as controls. RESULTS When analyzing risk factors, we have found that patients with ventriculoperitoneal shunt (VPS) (p = 0.03) or external ventricular drainage (EVD) (p = 0.005) placement had a greater chance of presenting a postoperative surgical site infection. Prolonged operative time (p < 0.001) and cerebrospinal fluid (CSF) leak through the wound (p = 0.002) also caused an increase in the risk of SSI in the postoperative period. A higher hemoglobin value (p = 0.002) would seem to be a preventive factor. CONCLUSIONS Some strategies that could help to reduce the risk of infections are managing hydrocephalus preferably with endoscopic third ventriculostomy, minimizing the needed operative time to perform the procedure, obtaining an adequate serum hemoglobin level, and avoiding CSF leak through the wound.
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Affiliation(s)
- Amparo Sáenz
- Neurosurgery Department, Juan P. Garrahan Children's Hospital, Buenos Aires, Argentina.
| | - Eugenia Badaloni
- Neurosurgery Department, Juan P. Garrahan Children's Hospital, Buenos Aires, Argentina
| | - Miguel Grijalba
- Neurosurgery Department, Juan P. Garrahan Children's Hospital, Buenos Aires, Argentina
| | - Juan F Villalonga
- Facultad de Medicina LINT , Universidad Nacional de Tucumán , Tucumán, Argentina
| | - Romina Argañaraz
- Neurosurgery Department, Juan P. Garrahan Children's Hospital, Buenos Aires, Argentina
| | - Beatriz Mantese
- Neurosurgery Department, Juan P. Garrahan Children's Hospital, Buenos Aires, Argentina
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3
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Evaluation of the costing methodology of published studies estimating costs of surgical site infections: A systematic review. Infect Control Hosp Epidemiol 2021; 43:898-914. [PMID: 34551830 DOI: 10.1017/ice.2021.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Surgical site infections (SSIs) are associated with increased length of hospitalization and costs. Epidemiologists and infection control practitioners, who are in charge of implementing infection control measures, have to assess the quality and relevance of the published SSI cost estimates before using them to support their decisions. In this review, we aimed to determine the distribution and trend of analytical methodologies used to estimate cost of SSIs, to evaluate the quality of costing methods and the transparency of cost estimates, and to assess whether researchers were more inclined to use transferable studies. METHODS We searched MEDLINE to identify published studies that estimated costs of SSIs from 2007 to March 2021, determined the analytical methodologies, and evaluated transferability of studies based on 2 evaluation axes. We compared the number of citations by transferability axes. RESULTS We included 70 studies in our review. Matching and regression analysis represented 83% of analytical methodologies used without change over time. Most studies adopted a hospital perspective, included inpatient costs, and excluded postdischarge costs (borne by patients, caregivers, and community health services). Few studies had high transferability. Studies with high transferability levels were more likely to be cited. CONCLUSIONS Most of the studies used methodologies that control for confounding factors to minimize bias. After the article by Fukuda et al, there was no significant improvement in the transferability of published studies; however, transferable studies became more likely to be cited, indicating increased awareness about fundamentals in costing methodologies.
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Evaluating the post-discharge cost of healthcare-associated infection in NHS Scotland. J Hosp Infect 2021; 114:51-58. [PMID: 34301396 DOI: 10.1016/j.jhin.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whereas the cost burden of healthcare-associated infection (HAI) extends beyond the inpatient stay into the post-discharge period, few studies have focused on post-discharge costs. AIM To investigate the impact of all types of HAI on the magnitude and distribution of post-discharge costs observed in acute and community services for patients who developed HAI during their inpatient stay. METHODS Using data from the Evaluation of Cost of Nosocomial Infection (ECONI) study and regression methods, this study identifies the marginal effect of HAI on the 90-daypost-discharge resource use and costs. To calculate monetary values, unit costs were applied to estimates of excess resource use per case of HAI. FINDINGS Post-discharge costs increase inpatient HAI costs by 36%, with an annual national cost of £10,832,437. The total extra cost per patient with HAI was £1,457 (95% confidence interval: 1,004-4,244) in the 90 days post discharge. Patients with HAI had longer LOS if they were readmitted and were prescribed more antibiotics in the community. The results suggest that HAI did not have an impact on the number of readmissions or repeat surgeries within 90 days of discharge. The majority (95%) of the excess costs was on acute care services after readmission. Bloodstream infection, gastrointestinal infection, and pneumonia had the biggest impact on post-discharge cost. CONCLUSION HAI increases costs and antibiotic consumption in the post-discharge period. Economic evaluations of IPC studies should incorporate post-discharge costs. These findings can be used nationally and internationally to support decision-making on the impact of IPC interventions.
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Flynn J, Choy A, Leavy K, Connolly L, Alards K, Ranasinha S, Tan PY. Negative Pressure Dressings (PICOTM) on Laparotomy Wounds Do Not Reduce Risk of Surgical Site Infection. Surg Infect (Larchmt) 2020; 21:231-238. [DOI: 10.1089/sur.2019.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Julie Flynn
- Department of Surgery, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Audrey Choy
- Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Kylie Leavy
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Lisa Connolly
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Kelly Alards
- Stomal Therapy Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive Medicine, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Pee Yau Tan
- Department of Surgery, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
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6
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Burden of surgical site infections in the Netherlands: cost analyses and disability-adjusted life years. J Hosp Infect 2019; 103:293-302. [PMID: 31330166 DOI: 10.1016/j.jhin.2019.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/15/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) are associated with morbidity, mortality and costs. AIM To identify the burden of (deep) SSIs in costs and disability-adjusted life years (DALYs) following colectomy, mastectomy and total hip arthroplasty (THA) in the Netherlands. METHODS A retrospective cost-analysis was performed using 2011 data from the national SSI surveillance network PREZIES. Sixty-two patients with an SSI (exposed) were matched to 122 patients without an SSI (unexposed, same type of surgery). Patient records were studied until 1 year after SSI diagnosis. Unexposed patients were followed for the same duration. Costs were calculated from the hospital perspective (2016 price level), and cost differences were tested using linear regression analyses. Disease burden was estimated using the Burden of Communicable Disease in Europe Toolkit of the European Centre for Disease Prevention and Control. The SSI model was specified by type of surgery, with country- and surgery-specific parameters where possible. FINDINGS Attributable costs per SSI were €21,569 (THA), €14,084 (colectomy) and €1881 (mastectomy), mainly caused by prolonged length of hospital stay. National hospital costs were estimated at €10 million, €29 million and €0.6 million, respectively. National disease burden was greatest for SSIs following colectomy (3200 DALYs/year, 150 DALYs/100 SSIs), while individual disease burden was highest following THA (1200 DALYs/year, 250 DALYs/100 SSIs). For mastectomy, these DALYs were <1. The total cost of DALYs for the three types of surgery exceeded €88 million. CONCLUSION Depending on the type of surgery, SSIs cause a significant burden, both economically and in loss of years in full health. This underlines the importance of appropriate infection prevention and control measures.
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7
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Sandy-Hodgetts K, Leslie GD, Lewin G, Hendrie D, Carville K. Surgical wound dehiscence in an Australian community nursing service: time and cost to healing. J Wound Care 2017; 25:377-83. [PMID: 27410391 DOI: 10.12968/jowc.2016.25.7.377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia. METHOD Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds. RESULTS Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost. CONCLUSION SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be 'at risk'. DECLARATION OF INTEREST The authors declare they have no competing interests.
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Affiliation(s)
- K Sandy-Hodgetts
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia
| | - G D Leslie
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia
| | - G Lewin
- Research Department, Silver Chain, Perth, Western Australia, Australia
| | - D Hendrie
- School of Public Health, Curtin University
| | - K Carville
- School of Nursing and Midwifery, Curtin University, Perth, Western Australia
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8
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Tierney N, LaCoursiere DY, Hebert S, Kelly TF, Lukacz ES. Incidence of wound complications after cesarean delivery: is suture closure better? J Matern Fetal Neonatal Med 2016; 30:1992-1996. [DOI: 10.1080/14767058.2016.1236080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nicole Tierney
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - D. Yvette LaCoursiere
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Steven Hebert
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Thomas F. Kelly
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Emily S. Lukacz
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, CA, USA
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9
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Coomer NM, Kandilov AM. Impact of hospital-acquired conditions on financial liabilities for Medicare patients. Am J Infect Control 2016; 44:1326-1334. [PMID: 27174461 DOI: 10.1016/j.ajic.2016.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospital-acquired conditions (HACs) can increase the financial liabilities faced by patients when the HACs require additional treatment both in the hospital and in subsequent health care encounters. This article estimates incremental effects of 6 HACs on Medicare beneficiary financial liabilities. METHODS Descriptive and multivariate analyses were used to examine the differences in beneficiary liability between care episodes with and without HACs. Episodes included the index hospitalization in which the HAC occurred and all inpatient, outpatient, and physician claims within 90 days of index hospital discharge. Medicare fee-for-service patients discharged from a hospital in fiscal year (FY) 2009 or FY 2010 with severe pressure ulcer, fracture, catheter-associated urinary tract infection, vascular catheter-associated infection, surgical site infection, or deep vein thrombosis or pulmonary embolism after certain orthopedic procedures were matched by diagnosis, sex, race, and age to with patients without HACs. RESULTS Medicare patients were liable for an additional $20.5 million per year across the HAC episodes compared with what they would have owed without the HACs. Beneficiaries with HACs were also more likely to exhaust their Part A days in the index hospitalization. CONCLUSIONS HACs create significant financial burden for Medicare beneficiaries. The incremental financial liabilities are concentrated in the episode of care after the index hospitalization with the HAC. Policies and programs that reduce HAC incidence will improve Medicare beneficiaries' physical and financial health.
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10
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. The silent overall burden of foot disease in a representative hospitalised population. Int Wound J 2016; 14:716-728. [PMID: 27696693 DOI: 10.1111/iwj.12683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/19/2022] Open
Abstract
The aims of this study were to investigate the point prevalence, and associated independent factors, for foot disease (ulcers, infections and ischaemia) in a representative hospitalised population. We included 733 (83%) of 883 eligible adult inpatients across five representative Australian hospitals on one day. We collected an extensive range of self-reported characteristics from participants. We examined all participants to clinically diagnose foot disease (ulcers, infections and ischaemia) and amputation procedures. Overall, 72 participants (9·8%) [95% confidence interval (CI):7·2-11·3%] had foot disease. Foot ulcers, in 49 participants (6·7%), were independently associated with peripheral neuropathy, peripheral arterial disease, previous foot ulcers, trauma and past surgeon treatment (P < 0·05). Foot infections, in 24 (3·3%), were independently associated with previous foot ulcers, trauma and past surgeon treatment (P < 0·01). Ischaemia, in 33 (4·5%), was independently associated with older age, smokers and past surgeon treatment (P < 0·01). Amputation procedures, in 14 (1·9%), were independently associated with foot infections (P < 0·01). We found that one in every ten inpatients had foot disease, and less than half of those had diabetes. After adjusting for diabetes, factors linked with foot disease were similar to those identified in diabetes-related literature. The overall inpatient foot disease burden is similar in size to well-known medical conditions and should receive similar attention.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD,, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD,, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD,, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD,, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD,, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Michael C d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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González-Vélez A, Romero-Martín M, Villanueva-Orbaiz R, Díaz-Agero-Pérez C, Robustillo-Rodela A, Monge-Jodra V. The cost of infection in hip arthroplasty: A matched case–control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Kinnear EM, d'Emden MC, Reed L. Direct inpatient burden caused by foot-related conditions: a multisite point-prevalence study. BMJ Open 2016; 6:e010811. [PMID: 27324710 PMCID: PMC4916592 DOI: 10.1136/bmjopen-2015-010811] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aims of this point-prevalence study were to investigate a representative inpatient population to determine the prevalence of people admitted to hospital for the reason of a foot-related condition, and identify associated independent factors. METHODS Participants were adult inpatients in 5 different representative hospitals, admitted for any reason on the day of data collection. Maternity, mental health and cognitively impaired inpatients were excluded. Participants were surveyed on a range of self-reported demographic, social determinant, medical history, foot disease history, self-care, footwear, past foot treatment prior to hospitalisation and reason for admission variables. Physical examinations were performed to clinically diagnose a range of foot disease and foot risk factor variables. Independent factors associated with being admitted to hospital for the primary or secondary reason of a foot-related condition were analysed using multivariate logistic regression. RESULTS Overall, 733 participants were included; mean (SD) age 62 (19) years, male 55.8%. Foot-related conditions were the primary reason for admission in 54 participants (7.4% (95% CI 5.7% to 9.5%)); 36 for foot disease (4.9%), 15 foot trauma (2.1%). Being admitted for the primary reason of a foot-related condition was independently associated with foot infection, critical peripheral arterial disease, foot trauma and past foot treatment by a general practitioner and surgeon (p<0.01). Foot-related conditions were a secondary reason for admission in 28 participants (3.8% (2.6% to 5.6%)), and were independently associated with diabetes and current foot ulcer (p<0.01). CONCLUSIONS This study, the first in a representative inpatient population, suggests the direct inpatient burden caused by foot-related conditions is significantly higher than previously appreciated. Findings indicate 1 in every 13 inpatients was primarily admitted because of a foot-related condition with most due to foot disease or foot trauma. Future strategies are recommended to investigate and intervene in the considerable inpatient burden caused by foot-related conditions.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vanessa Ng
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, Queensland, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, Queensland, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Michael C d'Emden
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lloyd Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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13
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Norman RE, Gibb M, Dyer A, Prentice J, Yelland S, Cheng Q, Lazzarini PA, Carville K, Innes-Walker K, Finlayson K, Edwards H, Burn E, Graves N. Improved wound management at lower cost: a sensible goal for Australia. Int Wound J 2016; 13:303-16. [PMID: 26634882 PMCID: PMC7949577 DOI: 10.1111/iwj.12538] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/18/2015] [Accepted: 10/07/2015] [Indexed: 12/18/2022] Open
Abstract
Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.
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Affiliation(s)
- Rosana E Norman
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| | - Michelle Gibb
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| | - Anthony Dyer
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| | | | | | - Qinglu Cheng
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Peter A Lazzarini
- Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland Health, Brisbane, QLD, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Keryln Carville
- Silver Chain Group, Perth, WA, Australia
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Karen Innes-Walker
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Kathleen Finlayson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Helen Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| | - Edward Burn
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
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14
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González-Vélez AE, Romero-Martín M, Villanueva-Orbaiz R, Díaz-Agero-Pérez C, Robustillo-Rodela A, Monge-Jodra V. The cost of infection in hip arthroplasty: a matched case-control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:227-33. [PMID: 27161768 DOI: 10.1016/j.recot.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 01/22/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Surgical site infection (SSI) represents 30% of all causes of health care-associated infection (HAI) and is one of the most dreaded complications in surgical patients. We estimated the excess direct costs of SSI using a matched nested case-control study in acute-term care at Ramon y Cajal University Hospital in Spain. MATERIAL AND METHOD Cases were patients who developed a first episode of SSI according to the criteria established by the CDC's National Healthcare Safety Network. Controls were matched to cases in 1:1 ratio taking into account the American Society of Anesthesiologists score, age, sex, surgery date, and principal diagnosis. RESULTS This study found that infection in hip replacement increased direct costs by 134%. Likewise, the excess cost due to the infections caused by methicillin resistant Staphylococcus aureus was 69% higher than the excess cost attributable to infections caused by other microorganisms. CONCLUSIONS SSI after hip replacement continues to be a costly complication from the hospital perspective. Costs due to SSI can be used to prioritise preventive interventions to monitor and control HAI.
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Affiliation(s)
| | - M Romero-Martín
- Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia, Universidad Complutense de Madrid, Madrid, España
| | - R Villanueva-Orbaiz
- Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia, Universidad Complutense de Madrid, Madrid, España
| | | | | | - V Monge-Jodra
- Hospital Universitario Ramón y Cajal, Madrid, España
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Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrea Herepath
- Sir Roland Smith Centre for Strategic Management, Department of Entrepreneurship, Strategy and Innovation, Lancaster University Management School, Lancaster University, Lancaster, UK
- Cardiff Business School, Cardiff University, Cardiff, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
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Tuffaha HW, Gillespie BM, Chaboyer W, Gordon LG, Scuffham PA. Cost-utility analysis of negative pressure wound therapy in high-risk cesarean section wounds. J Surg Res 2015; 195:612-22. [DOI: 10.1016/j.jss.2015.02.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/14/2015] [Accepted: 02/06/2015] [Indexed: 11/16/2022]
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Barnett AG, Page K, Campbell M, Martin E, Rashleigh-Rolls R, Halton K, Paterson DL, Hall L, Jimmieson N, White K, Graves N. The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case-control study. BMJ Open 2013; 3:e003587. [PMID: 24176795 PMCID: PMC3816236 DOI: 10.1136/bmjopen-2013-003587] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Hospital-acquired bloodstream infections are known to increase the risk of death and prolong hospital stay, but precise estimates of these two important outcomes from well-designed studies are rare, particularly for non-intensive care unit (ICU) patients. We aimed to calculate accurate estimates, which are vital for estimating the economic costs of hospital-acquired bloodstream infections. DESIGN Case-control study. SETTING 9 Australian public hospitals. PARTICIPANTS All the patients were admitted between 2005 and 2010. PRIMARY AND SECONDARY OUTCOME MEASURES Risk of death and extra length of hospital stay associated with nosocomial infection. RESULTS The greatest increase in the risk of death was for a bloodstream infection with methicillin-resistant Staphylococcus aureus (HR=4.6, 95% CI 2.7 to 7.6). This infection also had the longest extra length of stay to discharge in a standard bed (12.8 days, 95% CI 6.2 to 26.1 days). All the eight bloodstream infections increased the length of stay in the ICU, with longer stays for the patients who eventually died (mean increase 0.7-6.0 days) compared with those who were discharged (mean increase: 0.4-3.1 days). The three most common organisms associated with Gram-negative infection were Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumonia. CONCLUSIONS Bloodstream infections are associated with an increased risk of death and longer hospital stay. Avoiding infections could save lives and free up valuable bed days.
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Affiliation(s)
- Adrian G Barnett
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Katie Page
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Megan Campbell
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Elizabeth Martin
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Rebecca Rashleigh-Rolls
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
- Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - David L Paterson
- The University of Queensland Centre for Clinical Research, Queensland, Australia
- Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Queensland, Australia
| | - Lisa Hall
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
- Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Queensland, Australia
| | - Nerina Jimmieson
- School of Psychology, The University of Queensland, St Lucia, Queensland, Australia
| | - Katherine White
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
- Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Queensland, Australia
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Impact of surgical site infection after colorectal surgery on hospital stay and medical expenditure in Japan. Surg Today 2012; 42:639-45. [PMID: 22286573 DOI: 10.1007/s00595-012-0126-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 05/24/2011] [Indexed: 01/18/2023]
Abstract
PURPOSE To clarify the impact of surgical site infection (SSI) after colorectal surgery on the length of hospital stay and medical expenditure in Japan. METHODS This was a multi-center, retrospective-matched case-control study. RESULTS The total number of patients enrolled was 334 (167 case/control pairs). The average hospital stay after surgery was prolonged by 17.8 days (95% CI 11.9-23.5) and the average medical cost after surgery was increased by $5,938 (95% CI 3,610-8,367) in the SSI group versus the non-SSI group. Hospital charges comprised the largest among all cost categories and accounted for 53% of the additional cost. The hospital stay and medical costs both increased proportionately to the depth of the SSI, from 4.4 days and $608 for superficial incisional SSI, to 39.2 days and $14,448 for organ/space SSI. SSI caused by MRSA prolonged the hospital stay by 19.3 days and incurred an additional cost of $7,015. CONCLUSIONS SSI clearly prolonged the hospital stay and increased medical costs. The numerical values revealed by this study reinforce the medical-economic importance of instigating preventive measures against SSI.
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Robotham JV, Graves N, Cookson BD, Barnett AG, Wilson JA, Edgeworth JD, Batra R, Cuthbertson BH, Cooper BS. Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation. BMJ 2011; 343:d5694. [PMID: 21980062 PMCID: PMC3188660 DOI: 10.1136/bmj.d5694] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the cost effectiveness of screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus (MRSA) in intensive care units. DESIGN Economic evaluation based on a dynamic transmission model. SETTING England and Wales. Population Theoretical population of patients on an intensive care unit. MAIN OUTCOME MEASURES Infections, deaths, costs, quality adjusted life years (QALYs), incremental cost effectiveness ratios for alternative strategies, and net monetary benefits. RESULTS All decolonisation strategies improved health outcomes and reduced costs. Although universal decolonisation (regardless of MRSA status) was the most cost effective in the short term, strategies using screening to target MRSA carriers may be preferred owing to the reduced risk of selecting for resistance. Among such targeted strategies, universal admission and weekly screening with polymerase chain reaction coupled with decolonisation using nasal mupirocin was the most cost effective. This finding was robust to the size of intensive care units, prevalence of MRSA on admission, proportion of patients classified as high risk, and precise value of willingness to pay for health benefits. All strategies using isolation but not decolonisation improved health outcomes but costs were increased. When the prevalence of MRSA on admission to the intensive care unit was 5% and the willingness to pay per QALY gained was between £20,000 (€23,000; $32,000) and £30,000, the best such strategy was to isolate only those patients at high risk of carrying MRSA (either pre-emptively or after identification by admission and weekly screening for MRSA using chromogenic agar). Universal admission and weekly screening using polymerase chain reaction based detection of MRSA coupled with isolation was unlikely to be cost effective unless prevalence was high (10% of patients colonised with MRSA on admission). CONCLUSIONS MRSA control strategies that use decolonisation are likely to be cost saving in an intensive care unit setting provided resistance is lacking, and combining universal screening using polymerase chain reaction with decolonisation is likely to represent good value for money if untargeted decolonisation is considered unacceptable. In intensive care units where decolonisation is not implemented, evidence is insufficient to support universal screening for MRSA outside high prevalence settings.
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Affiliation(s)
- Julie V Robotham
- Modelling and Economics, Health Protection Agency, London NW9 5EQ, UK.
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Fuller RL, McCullough EC, Averill RF. A New Approach to Reducing Payments Made to Hospitals with High Complication Rates. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2011; 48:68-83. [DOI: 10.5034/inquiryjrnl_48.01.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article proposes a redesign of the Medicare inpatient prospective payment system to reduce payments made to hospitals with high complication rates. We compute risk-adjusted, expected complication rates for hospitals and compare them to actual complication rates in order to determine the number of excess complications. Hospital payment reductions then are computed based on the number of excess complications in a hospital. Medicare hospital payment could be reduced by approximately 8% ($8.5 billion) if hospitals were held to a “best practice” standard and if payments made for excess complications were eliminated.
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Crooks VA, Kingsbury P, Snyder J, Johnston R. What is known about the patient's experience of medical tourism? A scoping review. BMC Health Serv Res 2010; 10:266. [PMID: 20825667 PMCID: PMC2944273 DOI: 10.1186/1472-6963-10-266] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 09/08/2010] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Medical tourism is understood as travel abroad with the intention of obtaining non-emergency medical services. This practice is the subject of increasing interest, but little is known about its scope. METHODS A comprehensive scoping review of published academic articles, media sources, and grey literature reports was performed to answer the question: what is known about the patient's experience of medical tourism? The review was accomplished in three steps: (1) identifying the question and relevant literature; (2) selecting the literature; (3) charting, collating, and summarizing the information. Overall themes were identified from this process. RESULTS 291 sources were identified for review from the databases searched, the majority of which were media pieces (n = 176). A further 57 sources were included for review after hand searching reference lists. Of the 348 sources that were gathered, 216 were ultimately included in this scoping review. Only a small minority of sources reported on empirical studies that involved the collection of primary data (n = 5). The four themes identified via the review were: (1) decision-making (e.g., push and pull factors that operate to shape patients' decisions); (2) motivations (e.g., procedure-, cost-, and travel-based factors motivating patients to seek care abroad); (3) risks (e.g., health and travel risks); and (4) first-hand accounts (e.g., patients' experiential accounts of having gone abroad for medical care). These themes represent the most discussed issues about the patient's experience of medical tourism in the English-language academic, media, and grey literatures. CONCLUSIONS This review demonstrates the need for additional research on numerous issues, including: (1) understanding how multiple information sources are consulted and evaluated by patients before deciding upon medical tourism; (2) examining how patients understand the risks of care abroad; (3) gathering patients' prospective and retrospective accounts; and (4) the push and pull factors, as well as the motives of patients to participate in medical tourism. The findings from this scoping review and the knowledge gaps it uncovered also demonstrate that there is great potential for new contributions to our understanding of the patient's experience of medical tourism.
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Affiliation(s)
- Valorie A Crooks
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| | - Paul Kingsbury
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| | - Rory Johnston
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
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McKenzie S, Baek JH, Wakabayashi M, Garcia-Aguilar J, Pigazzi A. Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors' initial institutional experience. Surg Endosc 2010; 24:2048-52. [PMID: 20108143 DOI: 10.1007/s00464-009-0870-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 07/16/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND The persistence of early and delayed wound complications related to both open and laparoscopic colectomy remains a significant health burden. Furthermore, as interest in natural orifice translumenal endosurgery (NOTES) continues to grow, bridging techniques may help to attenuate the learning curve associated with NOTES. The authors present their technique and short-term outcomes for totally laparoscopic right colectomy with transvaginal specimen extraction in a series of four patients. METHODS Four consecutive patients from a prospectively maintained laparoscopic colectomy database were analyzed under an institutional review board-approved protocol. Clinicopathologic characteristics and short-term outcomes were reviewed. RESULTS All the patients were women with no prior pelvic surgery. A four-trocar laparoscopic right colectomy with intracorporeal anastomosis was performed for cancer in two cases and for adenomatous polyp in two cases. Transvaginal extraction was possible in all cases. The average operating room time was 212.25 min. No patient experienced complications associated with the colpotomy; nor did any patient have pain or drainage from the extraction site postoperatively. The median hospital stay was 4.5 days. One patient experienced a bowel obstruction unrelated to the extraction site. The mean specimen length was 27 cm, and the mean number of lymph nodes retrieved was 15.75. CONCLUSION Totally laparoscopic right colectomy with transvaginal extraction appears to be safe and feasible. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to NOTES colon surgery.
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Affiliation(s)
- Shaun McKenzie
- Department of General and Oncologic Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010-3000, USA.
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Gordon LG, Obermair A. Potential hospital cost-savings attributed to improvements in outcomes for colorectal cancer surgery following self-audit. BMC Surg 2010; 10:4. [PMID: 20105290 PMCID: PMC2835671 DOI: 10.1186/1471-2482-10-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 01/27/2010] [Indexed: 01/16/2023] Open
Abstract
Background One of the potential benefits of surgical audit is improved hospital cost-efficiencies arising from lower resource consumption associated with fewer adverse events. The aim of this study was to estimate the potential cost-savings for Australian hospitals from improved surgical performance for colorectal surgery attributed to a surgical self-audit program. Methods We used a mathematical decision-model to investigate cost differences in usual practice versus surgical audit and synthesized published hospital cost data with epidemiological evidence of adverse surgical events in Australia and New Zealand. A systematic literature review was undertaken to assess post-operative outcomes from colorectal surgery and effectiveness of surgical audit. Results were subjected to both one-way and probabilistic sensitivity analyses to address uncertainty in model parameters. Results If surgical self-audit facilitated the reduction of adverse surgical events by half those currently reported for colorectal cancer surgery, the potential cost-savings to hospitals is AU$48,720 (95% CI: $18,080-$89,260) for each surgeon treating 20 cases per year. A smaller 25% reduction in adverse events produced cost-savings of AU$24,960 per surgeon (95%CI: $1,980-$62,980). Potential hospital savings for all operative colorectal cancer cases was estimated at AU$30.3 million each year. Conclusions Surgical self-audit has the potential to create substantial hospital cost-savings for colorectal cancer surgery in Australia when considering the widespread incidence of this disease. The study is limited by the current availability and quality of data estimates abstracted from the published literature. Further evidence on the effectiveness of self-audit is required to substantiate these findings.
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Affiliation(s)
- Louisa G Gordon
- Queensland Institute of Medical Research, Genetics and Population Health Division, PO Royal Brisbane Hospital, Herston Q4029, Brisbane, Australia.
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Kasatpibal N, Nørgaard M, Jamulitrat S. Improving surveillance system and surgical site infection rates through a network: A pilot study from Thailand. Clin Epidemiol 2009; 1:67-74. [PMID: 20865088 PMCID: PMC2943169 DOI: 10.2147/clep.s5507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Indexed: 11/23/2022] Open
Abstract
Background: Surveillance of surgical site infections (SSI) provides data upon which interventions to improve patient safety can be based. In Thailand, however, SSI surveillance has not yet been standardized. Objectives: To develop a standardized SSI surveillance system and to monitor SSI rates after introduction of such a system. Methods: We conducted a prospective study among 17,752 patients who underwent surgery in ten hospitals in Thailand from April 2004 to May 2005. The SSI rates were computed and benchmarked with the US rates, reported in terms of standardized infection ratio (SIR). We estimated the incidence rate ratio of surgical site infections by comparing the incidence in the last study period with the incidence in the first study period. Results: The study included 17,869 operations and identified 248 SSIs, yielding an SSI rate of 1.4 infections/100 operations and a corresponding SIR of 0.6 (95% confidence interval [CI] = 0.5–0.7). During the study period the overall SSI rate decreased from 1.8 infections/100 operations to 1.2 infections/100 operations, yielding an incidence rate ratio of 0.65 (95% CI = 0.47–0.89). Conclusion: Our study highlighted that a standardized SSI surveillance in a developing country can be initiated through a network and may be followed by a decrease in SSI rates.
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Post-discharge surveillance to identify colorectal surgical site infection rates and related costs. J Hosp Infect 2009; 72:243-50. [PMID: 19446918 DOI: 10.1016/j.jhin.2009.03.021] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 03/31/2009] [Indexed: 11/20/2022]
Abstract
A growing number of surveillance studies have highlighted concerns with relying only on data from inpatients. Without post-discharge surveillance (PDS) data, the rate and burden of surgical site infections (SSIs) are underestimated. PDS data for colorectal surgery in the UK remains to be published. This is an important specialty to study since it is considered to have the highest SSI rate and is among the most expensive to treat. This study of colorectal SSI used a 30 day surveillance programme with telephone interviews and home visits. Each additional healthcare resource used by patients with SSI was documented and costed. Of the 105 patients who met the inclusion criteria and completed the 30 day follow-up, 29 (27%) developed SSI, of which 12 were diagnosed after discharge. The mean number of days to presentation of SSI was 13. Multivariable logistic analysis identified body mass index as the only significant risk factor. The additional cost of treating each infected patient was pound sterling 10,523, although 15% of these additional costs were met by primary care. The 5 month surveillance programme cost pound sterling 5,200 to run. An analysis of the surveillance nurse's workload showed that the nurse could be replaced by a healthcare assistant. PDS to detect SSI after colorectal surgery is necessary to provide complete data with accurate additional costs.
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