The impact of surgical site infections on hospital contribution margin-a European prospective observational cohort study

An evaluation study of direct economic losses from surgical site infections in adults: structural equation modeling

Introduction

Surgical site infection (SSI) represents a significant postoperative complication, resulting in extended hospital stays and substantial economic burdens. Previous research on the direct economic impact of SSIs using recursive systems modeling is limited. This study aims to quantify the direct economic losses attributable to SSIs and to dissect the various factors to these losses.

Methods

A retrospective 1:1 matched case-control study was conducted from January 2023 to March 2024 in three tertiary hospitals in Xinjiang, China. Patients with SSIs were matched on a 1:1 basis by hospital, department, age (±5 years), sex, primary diagnosis, and procedure with controls to form case and control groups. Wilcoxon Signed Ranks Test was utilized to quantify the direct economic loss from SSIs. Influencing factors were analyzed using a recursive system model.

Results

Among the 74,258 patients surveyed, 226 developed SSIs, resulting in an infection rate of 0.3%. The total direct economic loss from SSIs at three hospitals was $467,867, with an average loss of $1,364.37 per SSI patient. SSI patients experienced hospital stays 11 days longer than uninfected patients. Multivariate linear regression identified the duration of hospital stay, catheter and ventilator usage, age, number of surgeries, and duration of antibiotic treatment as influencing factors. Recursive system modeling revealed the indirect contributions of the number of surgeries (indirect effect: 0.074), antibiotic use for 17-36 days (indirect effect: 0.063) and ≥ 37 days (indirect effect: 0.045), and debridement procedures (indirect effect: 0.054), as well as the direct contributions of hospital days (direct effect: 0.276), indwelling catheter days (direct effect: 0.260), ventilator days (direct effect: 0.221), and age (direct effect: 0.182).

Conclusion

Recursive system modeling helped identify the key factors influencing the economic losses from SSIs. These findings provide a theoretical basis for healthcare departments to develop targeted policies.

Diagnosis-Related Groups payment reform and hospital cost control

BACKGROUND

This study explores the influence of Diagnosis-Related Groups (DRG) payment reform on hospital cost control and offers pertinent cost management strategies for public hospitals. It situates the research by elucidating the significance of the DRG payment method and comparing its advantages and drawbacks with the traditional 'pay per project' model.

OBJECTIVE

The primary aim is to assess the impact of DRG payment reform on hospital cost control and propose effective cost management strategies for public hospitals. The objective is to provide insights into DRG payment implications and attempt practical recommendations for its implementation in the public healthcare sector.

METHODS

Employing a comprehensive approach, the study analyzes DRG payment, delineates advantages and drawbacks, and proposes cost management strategies. Methods include staff training, an information management platform, disease analysis, and optimized cost accounting. The study highlights the potential for improved medical diagnosis and treatment through industry-finance integration.

RESULTS

Findings reveal advantages and limitations of DRG payment, emphasizing strategies for optimizing hospital operations. Enhanced medical diagnosis and treatment procedures through industry-finance integration contribute to overall cost control effectiveness.

CONCLUSION

The study serves as a practical guide for implementing DRG payment reforms, offering valuable insights for policymakers and healthcare professionals in navigating the complexities of cost control in public healthcare.

The Role of HbA1c as a Positive Perioperative Predictor of Surgical Site and Other Postoperative Infections: An Explorative Analysis in Patients Undergoing Minor to Major Surgery

Background

Patients with diabetes mellitus type 2 (DM2) inhere impaired peripheral insulin action leading to higher perioperative morbidity and mortality rates, with hospital-acquired infections being one important complication. This post hoc, observational study aimed to analyze the impact of surgical and metabolic stress as defined by the surrogate marker hemoglobin A1c (HbA1c), in relation to self-reported DM2, on perioperative infection rates in a subcohort of the Surgical Site Infection (SSI) Trial population.

Methods

All patients of the SSI study were screened for HbA1c levels measured perioperatively for elective or emergency surgery and classified according to the American Diabetes Association HbA1c cutoff values. SSI and nosocomial infections, self-reported state of DM2 and type of surgery (minor, major) were assessed.

Results

HbA1c levels were measured in 139 of 5175 patients (2.7%) of the complete SSI study group. Seventy patients (50.4%) self-reported DM2, while 69 (49.6%) self-reported to be non-diabetic. HbA1c levels indicating pre-diabetes were found in 48 patients (34.5%) and diabetic state in 64 patients (46%). Forty-five patients of the group self-reporting no diabetes (65.2%) were previously unaware of their metabolic derangement (35 pre-diabetic and 10 diabetic). Eighteen infections were detected. Most infections (17 of 18 events) were found in patients with HbA1c levels indicating pre-/diabetic state. The odds for an infection was 3.9-fold (95% CI 1.4 to 11.3) higher for patients undergoing major compared to minor interventions. The highest percentage of infections (38.5%) was found in the group of patients with an undiagnosed pre-/diabetic state undergoing major surgery.

Conclusions

These results encourage investment in further studies evaluating a more generous and specific use of HbA1c screening in patients without self-reported diabetes undergoing major surgery.

Trial registration Clinicaltrials.gov identifier: NCT 01790529

Evaluation of the costing methodology of published studies estimating costs of surgical site infections: A systematic review

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.