Olsen Margaret A, Tian Fang, Wallace Anna E, Nickel Katelin B, Warren David K, Fraser Victoria J, Selvam Nandini, Hamilton Barton H
*Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO †HealthCore, Inc, Wilmington, DE ‡Olin Business School, Washington University in St. Louis, St. Louis, MO.
Ann Surg. 2017 Feb;265(2):331-339. doi: 10.1097/SLA.0000000000001590.
To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution.
Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs.
We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery, anterior cruciate ligament reconstruction, and hernia repair from December 31, 2004 to December 31, 2010 using commercial insurer claims data. SSIs within 90 days post-procedure were identified; infections during a hospitalization or requiring surgery were considered serious. We used quantile regression, controlling for patient, operative, and postoperative factors to examine the impact of SSIs on 180-day health care costs throughout the cost distribution.
The incidence of serious and nonserious SSIs was 0.8% and 0.2%, respectively, after 21,062 anterior cruciate ligament reconstruction, 0.5% and 0.3% after 57,750 cholecystectomy, 0.6% and 0.5% after 60,681 hernia, and 0.8% and 0.8% after 42,489 breast-conserving surgery procedures. Serious SSIs were associated with significantly higher costs than nonserious SSIs for all 4 procedures throughout the cost distribution. The attributable cost of serious SSIs increased for both cholecystectomy and hernia repair as the quantile of total costs increased ($38,410 for cholecystectomy with serious SSI vs no SSI at the 70th percentile of costs, up to $89,371 at the 90th percentile).
SSIs, particularly serious infections resulting in hospitalization or surgical treatment, were associated with significantly increased health care costs after 4 common surgical procedures. Quantile regression illustrated the differential effect of serious SSIs on health care costs at the upper end of the cost distribution.
确定手术部位感染（SSIs）对常见门诊手术术后整个费用分布的医疗保健成本的影响。
关于门诊手术后手术部位感染成本的数据稀少，尤其是除平均成本之外的差异情况。
我们使用商业保险公司的理赔数据，对2004年12月31日至2010年12月31日期间接受胆囊切除术、保乳手术、前交叉韧带重建术和疝气修补术的患者进行了一项回顾性队列研究。确定术后90天内的手术部位感染；住院期间或需要手术治疗的感染被视为严重感染。我们使用分位数回归，控制患者、手术和术后因素，以研究手术部位感染对整个费用分布中180天医疗保健成本的影响。
在21062例前交叉韧带重建术后，严重和非严重手术部位感染的发生率分别为0.8%和0.2%；在57750例胆囊切除术后分别为0.5%和0.3%；在60681例疝气修补术后分别为0.6%和0.5%；在42489例保乳手术后分别为0.8%和0.8%。在整个费用分布中，对于所有4种手术，严重手术部位感染与显著更高的成本相关。随着总成本分位数的增加，胆囊切除术和疝气修补术严重手术部位感染的归因成本均增加（胆囊切除术严重手术部位感染与无感染相比，在成本第70百分位数时为38410美元，在第90百分位数时高达89371美元）。
手术部位感染，特别是导致住院或手术治疗的严重感染，与4种常见手术后显著增加的医疗保健成本相关。分位数回归说明了严重手术部位感染在费用分布上限对医疗保健成本的不同影响。
