ICAAC Highlights

Nosocomial surgical infections extend LOS

Infections translate into $1.9 million in costs

Researchers at LDS Hospital in Salt Lake City found that the average length of stay for patients with nosocomial surgical wound infections was nearly 10 days longer than for patients whose wounds did not become infected. The mean attributable difference in length of stay between these two groups was 5.3 days.

The investigators, who presented their findings at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy in San Diego, concluded that patients with nosocomial surgical wound infections had an average hospitalization cost of $18,621, compared with $6,030 for those without infections. The mean attributable difference in hospital costs between the two groups was $4,935.

5.3-day mean difference in LOS

During a 19-month period from Jan. 1, 1990, to Aug. 1, 1992, the average length of stay for patients whose surgical wounds became infected was 14.5 days. Matched control patients without infections spent an average of 4.7 days in the hospital. The mean attributable difference in length of stay between these two groups was 5.3 days.

The researchers also estimated the financial implications of nosocomial surgical wound infections at LDS Hospital. They found that wound infection added 2,061 inpatient days during the study period, which translated into a cost of $1.9 million. Thus, they argue, the negative effects of nosocomial surgical wound infections, both human and financial, provide a logical and rational focus for quality-of-care improvement and cost-containment efforts at hospitals.

Most studies failed to account for illness severity

According to the researchers, 500,000 to 1 million of the 23 million surgical procedures performed annually in the United States result in surgical wound infections. The numerous studies of this phenomenon, they say, suggest that the occurrence of nosocomial surgical wound infection is associated with poor outcomes, such as increased mortality or prolonged hospitalization. However, most of these studies failed to take into consideration the role that severity of illness plays as an independent predictor of poor outcomes and adverse events. Another shortcoming of the studies was that estimations of the effects of nosocomial surgical wound infections on hospital costs were based only on a percentage of hospital charges.

The LDS researchers, in contrast, used their hospital information system to assess the attributable effects of nosocomial surgical wound infections on hospital length of stay and cost of hospitalization. This allowed them to determine the difference between study group patients and control patients, not just an overall difference between patients with and without nosocomial surgical wound infections. Nursing acuity data were used to adjust severity of illness within diagnosis related groups. Actual hospital costs were addressed instead of charges or cost/charge ratios.