Division of Epidemiology and Infection Prevention, The Johns Hopkins Health System, Baltimore, Maryland6Department of Quality, Patient Safety, and Effectiveness, Stanford Hospital and Clinics, Stanford, California.
JAMA Surg. 2013 Oct;148(10):907-14. doi: 10.1001/jamasurg.2013.2246.
Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators.
To determine the change in hospital profit due to SSIs.
Retrospective study of data from January 1, 2007, to December 31, 2010.
The study was performed at 4 of The Johns Hopkins Health System acute care hospitals in Maryland: Johns Hopkins Bayview (560 beds); Howard County General Hospital (238 beds); The Johns Hopkins Hospital (946 beds); and Suburban Hospital (229 beds).
Eligible patients for the study included those patients admitted to the 4 hospitals between January 1, 2007, and December 31, 2010, with complete data and the correct International Classification of Diseases, Ninth Revision code, as determined by the infection preventionist. Infection preventionists performed complete medical record review using National Healthcare Safety Network definitions to identify SSIs. Patients were stratified using the All Patient Refined Diagnosis Related Groups to estimate the change in hospital profit due to SSIs.
Surgical site infections.
The outcomes of the study were the difference in daily total charges, length of stay (LOS), 30-day readmission rate, and profit for patients with an SSI when compared with patients without an SSI. The hypothesis, formulated prior to data collection, that patients with an SSI have higher daily total costs, a longer LOS, and higher 30-day readmission rates than patients without an SSI, was tested using a nonpaired Mann-Whitney U test, an analysis of covariance, and a Pearson χ2 test. Hospital charges were used as a proxy for hospital cost. RESULTS The daily total charges, mean LOS, and 30-day readmission rate for patients with an SSI compared with patients without an SSI were $7493 vs $7924 (P = .99); 10.56 days vs 5.64 days (P < .001); and 51.94 vs 8.19 readmissions per 100 procedures (P < .001). The change in profit due SSIs was $2 268 589.
The data suggest that hospitals have a financial incentive to reduce SSIs, but hospitals should expect to see an increase in both cost and revenue when SSIs are reduced.
手术部位感染（SSI）可能会增加医疗保健成本，但很少有研究从医院管理者的角度进行分析。
确定 SSI 导致的医院利润变化。
2007 年 1 月 1 日至 2010 年 12 月 31 日的数据回顾性研究。
马里兰州约翰霍普金斯卫生系统的 4 家急性护理医院：约翰霍普金斯湾景（560 张床位）；霍华德县综合医院（238 张床位）；约翰霍普金斯医院（946 张床位）；和郊区医院（229 张床位）。
符合研究条件的患者包括 2007 年 1 月 1 日至 2010 年 12 月 31 日期间在 4 家医院住院的患者，感染预防人员通过感染预防人员确定的完整数据和正确的国际疾病分类，第九修订版代码。感染预防人员使用国家医疗保健安全网络的定义进行了完整的病历回顾，以确定 SSI。患者使用所有患者精制诊断相关组进行分层，以估计 SSI 导致的医院利润变化。
手术部位感染。
本研究的结果是比较有 SSI 的患者和没有 SSI 的患者的每日总费用、住院时间（LOS）、30 天再入院率和利润差异。在数据收集之前提出的假设是，与没有 SSI 的患者相比，有 SSI 的患者的每日总费用更高，住院时间更长，30 天再入院率更高，这一假设通过非配对曼-惠特尼 U 检验、协方差分析和皮尔逊 χ2 检验进行了检验。医院收费用作医院成本的代理。结果：与没有 SSI 的患者相比，有 SSI 的患者的每日总费用、平均 LOS 和 30 天再入院率分别为$7493 美元和$7924 美元（P=0.99）；10.56 天与 5.64 天（P<0.001）；以及每 100 例手术 51.94 次与 8.19 次再入院（P<0.001）。SSI 导致的利润变化为$2268589。
数据表明，医院有减少 SSI 的经济动机，但当 SSI 减少时，医院预计成本和收入都会增加。
