Figuring Financial Impact of Surgical Site Infections With Cost Calculations

Surgical site infections cost millions of dollars and untold costs to patient health annually in the United States. At the Association for PeriOperative Nurses (AORN) held in San Antonio, Texas, on April 1-4, 2023, Infection Control Today^® spoke with Peter Graves, BSN, RN, CNOR, and Maureen Spencer, MEd, RN, CIC, FAPIC, infection preventionist consultant for the Boston, Massachusetts area about the financial impact of surgical site infections and what is causing them and what can be done to reduce SSIs in the United States. Their presentation was titled, “Grabbing the Bull by the Horns: The Financial Impact of Surgical Site Infections in the United States.”

“This team of [investigators] were able to use market scan. So [a] market scan is a database program software program that can pull in all the billing data from Medicare, Medicaid, IBM, and Premier, Spencer explained. You can then apply ICD 10 codes for the type of surgical site infection you're evaluating, pull those out, and then look at risk factors you can look at when did the infection happen. When was it first diagnosed? How long did the infection last, and what were the billing costs associated with that infection and all the readmissions or visits back to take care of that infection?”

Then the investigators examined 5 papers specifically, Spencer explained. They included a colorectal infection, an abdominal hysterectomy, one on spine surgery, and 2 on total hips and total knees. “When we looked at the onset of infections, we detected many that happened after the 30-day cutoff point, which you have for colorectal infections or anything that doesn't have hardware. If it does have hardware, like a total joint or spine hardware, it is 90 days [for cut-off]. We were finding infections way out past those cut-off times. …Then we looked at the billing cost of those infections. And it's, in some situations, triple what we thought infections were.”

“If you have fewer infections, what was the cost avoidance?" Spencer also said. "If you had more infections, what was the additional cost? And it's very helpful, I used that when I was a corporate director at Universal Health Services to justify some of the infection prevention products we wanted to bring in, showing the C suite at corporate how much these infections cost, even using those lower numbers. Using these numbers, now, it's that many more infections and that much more cost of these infections. That was the gist of the first half of the presentation with that cost calculator, giving them an idea of what you do with this data. What do you do with these numbers? Well, here's a simple way you could use it on your committees. I had all the infection prevention every month and fill out that cost calculator presented to the committee. We could see the potential cost and readmission costs that they were having with infections, which helps support that getting infection prevention products in place.”

Graves then discussed the second part of their presentation. “We did a prospective observational study looking at 3 hospitals across the United States. We were blinded to the hospitals' locations or their names. But we found that compliance of the guidelines was less than ideal, from 100%. And things like skin prep, and about 97% on IV antibiotics down to essentially 8%. And some hospitals have lower than that in oxygenation. So we looked at seven different elements that were associated with this. And it really made it a call to action...of the need to implement the colorectal bundle in all institutions, not just cherry-picking, what those specific elements might be that are easier to implement.”

Graves added, “In our study that looked at colorectal infections, At the 3 hospitals, one of the PIs [principal investigators] said we used to measure that one was a skip measure, but not anymore.’ Well, they're not skip measures; they have been tucked away for quite a while. It's important [to know] that those skip measures have been incorporated into other guidelines, in essence, or in total.”