Wick Elizabeth C, Hirose Kenzo, Shore Andrew D, Clark Jeanne M, Gearhart Susan L, Efron Jonathan, Makary Martin A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Arch Surg. 2011 Sep;146(9):1068-72. doi: 10.1001/archsurg.2011.117. Epub 2011 May 16.
To measure the effect of obesity on surgical site infection (SSI) rates and to define the cost of SSIs in patients undergoing colorectal surgery.
DESIGN, SETTING, AND PATIENTS: This is a retrospective cohort study of 7020 colectomy patients using administrative claims data from 8 Blue Cross and Blue Shield insurance plans. Patients who had a total or segmental colectomy for colon cancer, diverticulitis, or inflammatory bowel disease between January 1, 2002, and December 31, 2008, were included.
We compared 30-day SSI rates among obese and nonobese patients and calculated total costs from all health care claims for 90 days following surgery. Multivariate logistic regression was performed to identify risk factors for SSIs.
Obese patients had an increased rate of SSI compared with nonobese patients (14.5% vs 9.5%, respectively; P < .001). Independent risk factors for these infections were obesity (odds ratio = 1.59; 95% confidence interval, 1.32-1.91) and open operation as compared with a laparoscopic procedure (odds ratio = 1.57; 95% confidence interval, 1.25-1.97). The mean total cost was $31,933 in patients with infection vs $14,608 in patients without infection (P < .001). Total length of stay was longer in patients with infection than in those without infection (mean, 9.5 vs 8.1 days, respectively; P < .001), as was the probability of hospital readmission (27.8% vs 6.8%, respectively; P < .001).
Obesity increases the risk of an SSI after colectomy by 60%, and the presence of infection increases the colectomy cost by a mean of $17,324. Pay-for-performance policies that do not account for this increased rate of SSI and cost of caring for obese patients may lead to perverse incentives that could penalize surgeons who care for this population.
评估肥胖对手术部位感染（SSI）发生率的影响，并确定接受结直肠手术患者发生SSI的成本。
设计、研究地点与患者：这是一项回顾性队列研究，纳入了7020例接受结肠切除术的患者，使用了8家蓝十字蓝盾保险计划的管理索赔数据。纳入2002年1月1日至2008年12月31日期间因结肠癌、憩室炎或炎症性肠病接受全结肠或部分结肠切除术的患者。
我们比较了肥胖和非肥胖患者的30天SSI发生率，并计算了术后90天所有医疗索赔的总成本。进行多因素逻辑回归分析以确定SSI的危险因素。
与非肥胖患者相比，肥胖患者的SSI发生率更高（分别为14.5%和9.5%；P < 0.001）。这些感染的独立危险因素是肥胖（比值比 = 1.59；95%置信区间，1.32 - 1.91）以及与腹腔镜手术相比的开放手术（比值比 = 1.57；95%置信区间，1.25 - 1.97）。感染患者的平均总成本为31,933美元，未感染患者为14,608美元（P < 0.001）。感染患者的总住院时间比未感染患者长（分别为平均9.5天和8.1天；P < 0.001），再次入院的概率也是如此（分别为27.8%和6.8%；P < 0.001）。
肥胖使结肠切除术后发生SSI的风险增加60%，感染的存在使结肠切除术成本平均增加17,324美元。未考虑到这种SSI发生率增加和肥胖患者护理成本的按绩效付费政策可能会导致不良激励，可能会惩罚照顾这类患者的外科医生。
