Infections at the incision site occurred in more than 5 percent of patients following breast surgery and cost them more than $4,000 each in hospital-related expenses, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals.
Reported surgical site infection rates following mastectomy (surgical removal of the breast) and other breast procedures range from 1 percent to 28 percent, according to background information in the article. Given the state of fiscal constraints within the U.S. health care system, it is important to calculate the cost-effectiveness of infection control interventions to justify their use from an economic perspective, the authors write. Cost-effectiveness analyses require accurate estimates for the attributable costs of hospital-acquired infections, which are lacking for surgical site infections.
Margaret A. Olsen, Ph.D., M.P.H., of the Washington University School of Medicine, St. Louis, and colleagues studied 949 hospital admissions for mastectomy or breast reconstruction procedures at a university-affiliated hospital between 1999 and 2002. Surgical site infections were identified in an electronic hospital database and verified by review of medical records. Costs were taken from the hospital accounting database and included those from the original admission to the hospital for surgery as well as any readmissions within one year of surgery.
Surgical site infections were identified in 50 women within one year of surgery (5.3 percent). Infections were more common in patients undergoing cancer-related procedures, and occurred following 12.4 percent of mastectomies with immediate breast reconstruction using an implant; 6.2 percent of mastectomies with immediate breast reconstruction using abdominal tissue; 4.4 percent of mastectomies only and 1.1 percent of breast reduction surgeries. The average time between surgery and infection diagnosis was 46.6 days.
Patients with surgical site infections had significantly higher hospital costs associated with surgery and during the one-year period after surgery compared with uninfected patients, and they had a significantly longer total length of hospital stay, the authors write. After adjusting for the type of surgical procedure performed, breast cancer stage and other variables that influence cost, the cost of surgical site infections was $4,091 per patient.
Potential interventions to reduce the incidence of surgical site infections in this patient population 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, among others, the authors conclude. Interventions to reduce the incidence of surgical site infections following breast cancer surgical procedures are essential to reduce not only morbidity in these patient populations but also costs to the individuals and to society.
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