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Lookup NU author(s): Professor David Leaper
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© 2021 Elsevier Inc.Background: Surgical site infection posthysterectomy has significant impact on patient morbidity, mortality, and health care costs. This study evaluates incidence, risk factors, and total payer costs of surgical site infection after hysterectomy in commercial, Medicare, and Medicaid populations using a nationwide claims database. Methods: IBM MarketScan databases identified women having hysterectomy between 2014 and 2018. Deep-incisional/organ space (DI/OS) and superficial infections were identified over 6 months postoperatively with risk factors and direct infection-associated payments by insurance type over a 24-month postoperative period. Results: Analysis identified 141,869 women; 7.8% Medicaid, 5.8% Medicare, and 3.9% commercially insured women developed deep-incisional/organ space surgical site infection, whereas 3.9% Medicaid, 3.2% Medicare, and 2.1% commercially insured women developed superficial infection within 6 months of index procedure. Deep-incisional/organ space risk factors were open approach (hazard ratio, 1.6; 95% confidence interval, 1.5–1.8) and payer type (Medicaid versus commercial [hazard ratio, 1.4; 95% confidence interval, 1.3–1.5]); superficial risk factors were payer type (Medicaid versus commercial [hazard ratio, 1.4; 95% confidence interval, 1.3–1.6]) and solid tumor without metastasis (hazard ratio, 1.4; 95% confidence interval, 1.3–1.6). Highest payments occurred with Medicare ($44,436, 95% confidence interval: $33,967–$56,422) followed by commercial ($27,140, 95% confidence interval: $25,990–$28,317) and Medicaid patients ($17,265, 95% confidence interval: $15,247–$19,426) for deep-incisional/organ space infection at 24-month posthysterectomy. Conclusions: Real-world cost of managing superficial, deep-incisional/organ space infection after hysterectomy was significantly higher than previously reported. Surgical approach, payer type, and comorbid risk factors contributed to increased risk of infection and economic burden. Medicaid patients experienced the highest risk of infection, followed by Medicare patients. The study suggests adoption of a robust evidence-based surgical care bundle to mitigate risk of surgical site infection and economic burden is warranted.
Author(s): Edmiston CE, Bond-Smith G, Spencer M, Chitnis AS, Holy CE, Po-Han Chen B, Leaper DJ
Publication type: Article
Publication status: Published
Journal: Surgery
Year: 2022
Volume: 171
Issue: 5
Pages: 1320-1330
Print publication date: 01/05/2022
Online publication date: 29/12/2021
Acceptance date: 29/11/2021
ISSN (print): 0039-6060
ISSN (electronic): 1532-7361
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.surg.2021.11.034
DOI: 10.1016/j.surg.2021.11.034
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