Keywords:
resource allocation
healthcare-associated infections
economic impact
infection control
cost analysis
antibiotic therapy

  • Abstract

    Surgical site infection (SSI) therefore poses a worldwide threat to morbidity and mortality as well as financial implications. A significant anatomic and physiologic change results in surgical site infection management, increasing medical costs for hospitals, such as surgeries, tests, imaging, medications, wound care, infection control, and treatments. The aim is to identify the economic burden of SSI in terms of costs, resource utilization, effects on healthcare personnel, and means of reducing the cost burden. In this respect, SSIs increase the financial burden of hospitals through cost per patient stay, increased revenue cuts from reimbursement, and long lengths of stay for affected patients. The primary cause of this is the adverse health impacts that occur in people infected with the virus, which can lead to sickness or even death. Some of the findings highlighted in this research documentation report that SSIs significantly contribute to increased hospital costs, as a result of longer hospital stays and increased use of resources such as antibiotics and surgical procedures. Because the costs associated with managing SSIs are only associated with patients and healthcare systems, it is important to promote targeted interventions to reduce this complication. However, the lack of resources in health institutions in developing countries means that the necessary resources are lacking, thus causing enormous negative impacts on patients. This review was conducted to assess the cost consequences of healthcare-associated SSIs and their consequences for patients. The implementation and adoption of best practices, antimicrobial stewardship, and quality improvement of SSIs can improve patients’ experiences and optimize hospital resources. In conclusion, several considerable direct and indirect costs are associated with SSIs.

  • References

    1. Alonso-Aguilar, N. M., Juarez-Enriquez, S. R., Castro-Escarpulli, G., Rivera, G., Bocanegra-Garcia, V., Guo, X., Luna-Herrera, J., & Aguilera-Arreola, M. G. (2017). Aetiology and Significance of Hospital-Acquired Infections in Mexico. Clinical Laboratory, 63(2), 207–218. https://doi.org/10.7754/Clin.Lab.2016.151119
    2. Assefa, J., Alen, G. D., & Adane, S. (2020). Infection prevention knowledge, practice, and its associated factors among healthcare providers in primary healthcare unit of Wogdie District, Northeast Ethiopia, 2019: A cross-sectional study. Antimicrobial Resistance & Infection Control, 9(1), 136. https://doi.org/10.1186/s13756-020-00802-w
    3. Badia, J. M., Casey, A. L., Petrosillo, N., Hudson, P. M., Mitchell, S. A., & Crosby, C. (2017). Impact of surgical site infection on healthcare costs and patient outcomes: A systematic review in six European countries. Journal of Hospital Infection, 96(1), 1–15. https://doi.org/10.1016/j.jhin.2017.03.004
    4. Barnes, C. L. (2011). Overview: the health care burden and financial costs of surgical site infections. American Journal of Orthopedics (Belle Mead, NJ), 40(12), 2-5.
    5. Boltz, M. M., Hollenbeak, C. S., Julian, K. G., Ortenzi, G., & Dillon, P. W. (2011). Hospital costs associated with surgical site infections in general and vascular surgery patients. Surgery, 150(5), 934–942. https://doi.org/10.1016/j.surg.2011.04.006
    6. Broex, E. C. J., van Asselt, A. D. I., Bruggeman, C. A., & van Tiel, F. H. (2009). Surgical site infections: How high are the costs? The Journal of Hospital Infection, 72(3), 193–201. https://doi.org/10.1016/j.jhin.2009.03.020
    7. Clements, A. C. A., Tong, E. N. C., Morton, A. P., & Whitby, M. (2007). Risk stratification for surgical site infections in Australia: Evaluation of the US National Nosocomial Infection Surveillance risk index. The Journal of Hospital Infection, 66(2), 148–155. https://doi.org/10.1016/j.jhin.2007.02.019
    8. Costabella, F., Patel, K. B., Adepoju, A. V., Singh, P., Mahmoud, H. A. H., Zafar, A., Patel, T., Watekar, N. A., Mallesh, N., Fawad, M., Sathyarajan, D. T., Abbas, K., Costabella, F., Patel, K. B., Adepoju, A. V., Singh, P., Mahmoud, H. A. H., Zafar, A., Patel, T., … Abbas, K. (2023). Healthcare Cost and Outcomes Associated With Surgical Site Infection and Patient Outcomes in Low- and Middle-Income Countries. Cureus, 15(7). https://doi.org/10.7759/cureus.42493
    9. Culver, D. H., Horan, T. C., Gaynes, R. P., Martone, W. J., Jarvis, W. R., Emori, T. G., Banerjee, S. N., Edwards, J. R., Tolson, J. S., & Henderson, T. S. (1991). Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. The American Journal of Medicine, 91(3B), 152S-157S. https://doi.org/10.1016/0002-9343(91)90361-z
    10. Dal-Paz, K., Oliveira, P. R. D., Paula, A. P. de, Emerick, M. C. da S., Pécora, J. R., & Lima, A. L. L. M. (2010). Economic impact of treatment for surgical site infections in cases of total knee arthroplasty in a tertiary public hospital in Brazil. The Brazilian Journal of Infectious Diseases: An Official Publication of the Brazilian Society of Infectious Diseases, 14(4), 356–359. https://doi.org/10.1016/S1413-8670(10)70075-1
    11. De Angelis, G., Murthy, A., Beyersmann, J., & Harbarth, S. (2010). Estimating the impact of healthcare-associated infections on length of stay and costs. Clinical microbiology and infection, 16(12), 1729-1735.
    12. Fenny, A. P., Asante, F. A., Otieku, E., Bediako-Bowan, A., & Enemark, U. (2020). Attributable cost and extra length of stay of surgical site infection at a Ghanaian teaching hospital. Infection Prevention in Practice, 2(2), 100045. https://doi.org/10.1016/j.infpip.2020.100045
    13. Gillespie, B. M., Harbeck, E., Rattray, M., Liang, R., Walker, R., Latimer, S., ... & Chaboyer, W. (2021). Worldwide incidence of surgical site infections in general surgical patients: a systematic review and meta-analysis of 488,594 patients. International Journal of Surgery, 95, 106136.
    14. Graves, N., Harbarth, S., Beyersmann, J., Barnett, A., Halton, K., & Cooper, B. (2010). Estimating the cost of health care-associated infections: Mind your p’s and q’s. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 50(7), 1017–1021. https://doi.org/10.1086/651110
    15. Hirani, S., Trivedi, N. A., Chauhan, J., & Chauhan, Y. (2022). A study of clinical and economic burden of surgical site infection in patients undergoing caesarian section at a tertiary care teaching hospital in India. PLOS ONE, 17(6), e0269530. https://doi.org/10.1371/journal.pone.0269530
    16. Guzman-Herrador, B., Molina, C. D., Allam, M. F., & Navajas, R. F. C. (2016). Independent risk factors associated with hospital-acquired pneumonia in an adult ICU: 4-year prospective cohort study in a university reference hospital. Journal of Public Health, 38(2), 378-383.
    17. Ling, M. L., Apisarnthanarak, A., Abbas, A., Morikane, K., Lee, K. Y., Warrier, A., & Yamada, K. (2019). APSIC guidelines for the prevention of surgical site infections. Antimicrobial Resistance and Infection Control, 8, 174. https://doi.org/10.1186/s13756-019-0638-8
    18. Melaku, S., Gebre-Selassie, S., Damtie, M., & Alamrew, K. (2012). Hospital acquired infections among surgical, gynaecology and obstetrics patients in Felege-Hiwot referral hospital, Bahir Dar, northwest Ethiopia. Ethiopian medical journal, 50(2), 135-144.
    19. Mengistu, D. A., Alemu, A., Abdukadir, A. A., Mohammed Husen, A., Ahmed, F., Mohammed, B., & Musa, I. (2023). Global Incidence of Surgical Site Infection Among Patients: Systematic Review and Meta-Analysis. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 60, 00469580231162549. https://doi.org/10.1177/00469580231162549
    20. Monahan, M., Jowett, S., Pinkney, T., Brocklehurst, P., Morton, D. G., Abdali, Z., & Roberts, T. E. (2020). Surgical site infection and costs in low- and middle-income countries: A systematic review of the economic burden. PloS One, 15(6), e0232960. https://doi.org/10.1371/journal.pone.0232960
    21. Olsen, M. A., Butler, A. M., Willers, D. M., Gross, G. A., Hamilton, B. H., & Fraser, V. J. (2010). Attributable costs of surgical site infection and endometritis after low transverse cesarean delivery. Infection Control and Hospital Epidemiology, 31(3), 276–282. https://doi.org/10.1086/650755
    22. Patel, H., Khoury, H., Girgenti, D., Welner, S., & Yu, H. (2017). Burden of surgical site infections associated with select spine operations and involvement of Staphylococcus aureus. Surgical infections, 18(4), 461-473.
    23. Piednoir, E., Robert-Yap, J., Baillet, P., Lermite, E., & Christou, N. (2021). The Socioeconomic Impact of Surgical Site Infections. Frontiers in Public Health, 9, 712461. https://doi.org/10.3389/fpubh.2021.712461
    24. Roberts, R. R., Scott, R. D., Hota, B., Kampe, L. M., Abbasi, F., Schabowski, S., Ahmad, I., Ciavarella, G. G., Cordell, R., Solomon, S. L., Hagtvedt, R., & Weinstein, R. A. (2010). Costs attributable to healthcare-acquired infection in hospitalized adults and a comparison of economic methods. Medical Care, 48(11), 1026–1035. https://doi.org/10.1097/MLR.0b013e3181ef60a2
    25. Shepard, J., Ward, W., Milstone, A., Carlson, T., Frederick, J., Hadhazy, E., & Perl, T. (2013). Financial Impact of Surgical Site Infections on Hospitals: The Hospital Management Perspective. JAMA Surgery, 148(10), 907–914. https://doi.org/10.1001/jamasurg.2013.2246
    26. Sparling, K. W., Ryckman, F. C., Schoettker, P. J., Byczkowski, T. L., Helpling, A., Mandel, K., Panchanathan, A., & Kotagal, U. R. (2007). Financial impact of failing to prevent surgical site infections. Quality Management in Health Care, 16(3), 219–225. https://doi.org/10.1097/01.QMH.0000281058.99929.ea
    27. Sullivan, E., Gupta, A., & Cook, C. H. (2017). Cost and Consequences of Surgical Site Infections: A Call to Arms. Surgical Infections, 18(4), 451–454. https://doi.org/10.1089/sur.2017.072
    28. World Health Organization. (2024). Global strategy on infection prevention and control. World Health Organization.
    29. Turner, M. C., & Migaly, J. (2019). Surgical site infection: the clinical and economic impact. Clinics in colon and rectal surgery, 32(03), 157-165.
    30. Maksimović, J., Marković-Denić, L., Bumbaširević, M., Marinković, J., & Vlajinac, H. (2008). Surgical site infections in orthopedic patients: prospective cohort study. Croatian medical journal, 49(1), 58.
    31. Tevis, S. E., & Kennedy, G. D. (2016). Postoperative Complications: Looking Forward to a Safer Future. Clinics in Colon and Rectal Surgery, 29(03), 246–252. https://doi.org/10.1055/s-0036-1584501
    32. Monahan, M., Glasbey, J., Roberts, T. E., Jowett, S., Pinkney, T., Bhangu, A., ... & De la Medina, A. R. (2023). The costs of surgical site infection after abdominal surgery in middle-income countries: Key resource use In Wound Infection (KIWI) study. Journal of Hospital Infection, 136, 38-44.
    33. Urquhart, J. C., Gurr, K. R., Siddiqi, F., Rasoulinejad, P., & Bailey, C. S. (2021). The Impact of Surgical Site Infection on Patient Outcomes After Open Posterior Instrumented Thoracolumbar Surgery for Degenerative Disorders. JBJS, 103(22), 2105. https://doi.org/10.2106/JBJS.20.02141
    34. Weber, W. P., Zwahlen, M., Reck, S., Feder-Mengus, C., Misteli, H., Rosenthal, R., Brandenberger, D., Oertli, D., Widmer, A. F., & Marti, W. R. (2008). Economic burden of surgical site infections at a European university hospital. Infection Control and Hospital Epidemiology, 29(7), 623–629. https://doi.org/10.1086/589331
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Nimkar, P., & Kanyal, D. (2024). Understanding the financial burden of surgical site infections: A narrative review . Multidisciplinary Reviews, 8(3), 2025084. https://doi.org/10.31893/multirev.2025084
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