Extra Charge and Extra Length of Postoperative Stay Attributable to Surgical Site Infection in Six Selected Operations
Nongyao Kasatpibal, RN, MNS*, Somchit Thongpiyapoom, RN**, Montha Na Narong, RN**, Nonglak Suwalak, RN, MPA**, Silom Jamulitrat, MD***
Affiliation : * Faculty of Nursing, Chiang Mai University, Chiang Mai ** Infection Control Unit, Songklanagarind Hospital, Songkhla *** Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Chiang Mai
Background : Information concerning the economic impact of surgical site infection (SSI) is very rare in
Thailand. As the national health care financial system has been changing, the need for such data is critical.
Objective : The purpose of this study is to estimate the extra charge and excess postoperative hospitalization
attributable to SSI in six surgical operative procedures comprising appendectomy, herniorrhaphy, mastec-
tomy, cholecystectomy, colectomy, and craniotomy.
Materials and Methods : The study population consisted of patients undergoing major operations admitted to
Songklanagarind Hospital from January, 1998 to December, 2003. Data were prospectively collected to
identify demographic data, surgical operations, development of SSI, and outcomes of SSI. The study used
one-to-one matched-pair strategy to compare case (patient with SSI) and controls (patient without SSI). The
matching criteria were same final diagnosis, same operative procedure, and same American Society of
Anesthesiologists (ASA) score. Data were calculated for mean difference, median difference, and 95% confi-
dence intervals (95% C.I) of hospital charge and postoperative stay.
Results : The study could identify 140 matched-pairs of case and control. When compared to matched con-
trols, cases had higher hospital charge and greater postoperative length of stay. Mean of extra hospital
charge attributable to SSI was 43,658 (95% C.I; 30,228-57,088) baht and mean of excess postoperative stay
was 21.3 (95% C.I; 16.6-26.0) days. Median of extra expenditure was 31,140 (95% CI; 17,327-49,081) baht
and median of prolongation of postoperative stay was 14 (95% C.I, 12-18) days.
Conclusion : This study supports the findings of the previous published reports that patients who have SSI
incur enormous excess cost and hospital stay.
Keywords : Cost of illness, Costs, Cost analysis, Cross infection, Surgical site infection
