104© 2010 TMIT

Robert Cima, MD, MA

Consultant in Colorectal SurgeryVice Chairman, Quality and Safety, Department of Surgery

Mayo Clinic

TMIT High Performer WebinarOctober 28, 2010

Economic Cost of a Surgical-SiteInfection

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Economic Cost of a SurgicalEconomic Cost of a SurgicalSite Infection (SSI) at a SingleSite Infection (SSI) at a Single

InstitutionInstitution

Robert R. Cima, MD, MARobert R. Cima, MD, MAViceVice--chairman Department of Surgerychairman Department of Surgery

Mayo ClinicMayo Clinic

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Difficulty in Determining SSI CostDifficulty in Determining SSI Cost

•• Heterogeneous patient populationsHeterogeneous patient populations

•• Healthy vs. SickHealthy vs. Sick

•• Heterogeneous proceduresHeterogeneous procedures

•• Low risk vs. High RiskLow risk vs. High Risk

•• PostPost--operative confounders makeoperative confounders make“attribution” of cost difficult“attribution” of cost difficult

•• Exacerbation of chronic conditionsExacerbation of chronic conditions

•• Other acute conditions (MI,Other acute conditions (MI,pneumonia)pneumonia)

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Cost of SSI after Colectomy at aCost of SSI after Colectomy at aSingle InstitutionSingle Institution

•• One hospital (Mayo Clinic, Rochester), 8 board certifiedOne hospital (Mayo Clinic, Rochester), 8 board certifiedcolon and rectal surgeons, >2,300colon and rectal surgeons, >2,300 colectomiescolectomies/year/year

•• National Surgical Quality Improvement Project (NSQIP)National Surgical Quality Improvement Project (NSQIP)datadata--setset

•• Systematic sampling of allSystematic sampling of all colectomiescolectomies•• Data abstracted by trained nurse abstractorsData abstracted by trained nurse abstractors•• Collect extensive preCollect extensive pre--op (n=63), intraop (n=63), intra--op (n=30) variables, and postop (n=30) variables, and post--operativeoperative

data (20 complications, 30 day outcomes)data (20 complications, 30 day outcomes)•• RiskRisk--adjustment performedadjustment performed

•• MCR NSQIP database has >8,000 patients over 4 yearsMCR NSQIP database has >8,000 patients over 4 years•• Compared hospital billing cost ofCompared hospital billing cost of colectomiescolectomies withoutwithout

any postany post--operative complications (n=1,881) tooperative complications (n=1,881) tocolectomiescolectomies withwith onlyonly a posta post--operative SSI adverseoperative SSI adverseevent (n= 161)event (n= 161)

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ResultsResultsAll CPT codes No SSI

N=1881Any SSIN=161

CostDifference

p-value

Median Costs (IQR) $16,782(13,324 – 21,887)

$20,811(15,991 – 38,863)

$4029 <0.0001

Superficial SSIN=98

Median Costs (IQR) $16,782(13,324 – 21,887)

$18,875(14,796 – 27,829)

$2093 <0.0001

Deep SSIN=13

Median Costs (IQR) $16,782(13,324 – 21,887)

$27,711(18,751 – 39,435)

$10,929 <0.0001

Organ SSIN=50

Median Costs (IQR) $16,782(13,324 – 21,887)

31,416(17,709 – 44,867)

$14,634 <0.0001

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SummarySummary

•• A SSI afterA SSI after colectomycolectomy at a single highat a single highvolume institution resulted in avolume institution resulted in asignificant increase in the cost ofsignificant increase in the cost ofcare (median increase $4,029)care (median increase $4,029)

•• The most common, superficial woundThe most common, superficial woundinfection, caused a significantinfection, caused a significantincrease (median increase $2,093)increase (median increase $2,093)

•• Efforts to reduce SSI would result inEfforts to reduce SSI would result ina significant decrease in posta significant decrease in post--operative costs and patient morbidityoperative costs and patient morbidity