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Economic effects of nosocomial infections in cardiac surgery
Journal
of Hospital
Infection
(1990)
16, 339-341
SHORT
Economic
effects of nosocomial cardiac surgery Li Liu-yi
Institute
REPORT
and Wang
infections
in
Shu-qun
of Epidemiology and Microbiology, Chinese Academy of Preventive Medicine, Beijing, People’s Republic of China Accepted for publication
4 July
1990
Summary:
A study of 60 infected patients and matched controls showed that nosocomial infection in cardiac surgery cost each patient an additional 2207 yuan (E290). The cost of multisite infection was much higher. Infected patients were in hospital for a mean of 14 extra days.
Keywords:
Nosocomial
infection;
cardiac
surgery;
costs.
Introduction Nosocomial infections prolong hospital stay, increase suffering of patients and are an additional burden to staff (Freeman, 1979; Haley et al., 1980; Daschner, 1984). Costs of drugs, laboratory tests and other services are ail increased. Studies have been published on costs of postoperative wound infection (Green et al., 1977) but not on cardiac surgery. Patients undergoing cardiac surgery are particularly susceptible to infection due to the multiplicity of invasive procedures and prolonged operating time, and the infections are often severe. The present paper reports a case control study on the economic effects of nosocomial infection in cardiac surgery. Materials
and methods
The study was undertaken in a cardiovascular surgery hospital containing three wards and 150 beds. All patients undergoing surgery between December 1986 and December 1987 were included, and data were recorded on special forms. The definitions of infection were based on those proposed by the Centers for Disease Control (1975). Correspondence Beijing, Peoples’ 019556701/90/080339+03
to: Li Liu-yi MD, Republic of China.
Department
to Epidemiology,
$03,00/O
3 Yabas
Rd,
Chaoyang
0 1990 The Hospital
339
District,
Infection
Society
L. Liu-yi
340
and W. Shu-qun
Infected cases were matched with uninfected patients in the same period using the following data: sex, underlying disease, surgical procedure, age (not more than a 3-year difference) and preoperative stay (not more than a 3-day difference). Any patient infected on admission or for whom a matched control could not be found was excluded. Control patients were rejected if their duration of postoperative stay was not at least as long as the time between operation and infection in the corresponding infected patient. Charges to patients on drugs, blood transfusions, laboratory tests, X-ray, medical care, oxygen therapy and hospital costs were recorded and analysed by the SYSTAT statistical package. Results
During the 13-month period, 1207 patients were admitted and 90 acquired an infection. The infected patients were matched with suitable controls where possible, but 11 were excluded because information on charges was lost. Suitable controls were not available for 19 cases, and these were also excluded. No significant difference was found between the 60 matched cases and controls (Table I). The additional charges for patients with nosocomial infection are shown in Table II. All were higher than controls, apart from the cost of the operation. The overall additional cost per patient was 2207 Yuan (approximately E290). The mean additional costs were particularly high in patients with multisite infections (E782) and were higher in lower respiratory tract than in postoperative wound infection. The postoperative stay was longer in all types of infection, but particularly in patients with multisite infections (Table III) Discussion
The additional costs of nosocomial infection are well known (Haley et al. 1980), but an extra 2207 Yuan (E290) is a considerable burden for Chinese families. This would be much higher if indirect costs were included.
Table
I.
The results
Mean age (years) Cases Controls * A, Patent ductus Fallot correction;
:4 arteriosus; D, prosthetic
of case and Sex
Male 30 30 B, atria1 valve
Female
control
pair
Mean preoperative stay (days)
(60
or ventricular
septal
pairs)
Type
of operation*
A
B
C
D
8 8
;i
:;
10 10
23 22
:: septal defect replacement.
matching
defect
surgery;
C, tetralogy
of
Infections Table
II.
The extra
charges
Average charge (Yuan) for infected patients (A) 1306 1397 387 87 47
Drugs Blood transfusion Lab. examinations X-rays Operation Treatment Oxygen therapy Hospitalization Total * NS, Not
in cardiac
(172) (184) (51) (11) (6)
to patients
with
infection
Extra charge (Yuan) for infected patients (E)
(67) (100) (28) (7) (6) (198)
P value
< < < <
174 (23) 32 (4) 42: (56) 70 (9) 52 (7j 2207 (290)
(81 (13) (427)
< < < <
0.001 0.001 0.001 0.05 NS* 0.01 0.001 0.001 0.001
significant.
Table
III.
Prolongation
of hospitalization
due to nosocomial Hospitalization
Type
341
nosocomial
Average charge (Yuan) for control patients (E) 509 758 213 55 47 1504 58 92 3245
144 (i9j 5452 (717)
surgery
of infection
(pairs)
Lower respiratory tract infection (27) Postoperative wound infection (17) Multisite infections (10) Other (6) Total (60)
infections
(days)
Case
Control
Difference
P value
22 26 43 19 27
12 Ei
10 14 25 1:
-c 0.01 -=c 0.01 < 0.01 < 0.01 ‘c 0.01
IO 13
A case control study is a useful method for reducing possible bias, but even with an exact match the costs were not entirely comparable, since the patients with nosocomial infection had more complications other than infection than the controls. References Centers for Disease Control (1975). National Nosocomial Infection Study Site Dejinitions Manual (unpublished). Atlanta: Centers for Disease Control. Daschner, F. D. (1984). The costs of hospital-acquired infections. Journal of Hospital Infection 5 (Suppl. A), 27. Freeman, J. et al. (1979). Adverse effects of nosocomial infection. Journal of Infectious Diseases 140, 732. Green, J. W. et al. (1977). Postoperative wound infection: A controlled study of the increased duration of hospital stay and direct cost of hospitalization. Annals of Surgery 155, 624. Haley, R. M. et aZ. (1980). Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. Journal of Infectious Diseases
141, 248.
of Hospital
Infection
(1990)
16, 339-341
SHORT
Economic
effects of nosocomial cardiac surgery Li Liu-yi
Institute
REPORT
and Wang
infections
in
Shu-qun
of Epidemiology and Microbiology, Chinese Academy of Preventive Medicine, Beijing, People’s Republic of China Accepted for publication
4 July
1990
Summary:
A study of 60 infected patients and matched controls showed that nosocomial infection in cardiac surgery cost each patient an additional 2207 yuan (E290). The cost of multisite infection was much higher. Infected patients were in hospital for a mean of 14 extra days.
Keywords:
Nosocomial
infection;
cardiac
surgery;
costs.
Introduction Nosocomial infections prolong hospital stay, increase suffering of patients and are an additional burden to staff (Freeman, 1979; Haley et al., 1980; Daschner, 1984). Costs of drugs, laboratory tests and other services are ail increased. Studies have been published on costs of postoperative wound infection (Green et al., 1977) but not on cardiac surgery. Patients undergoing cardiac surgery are particularly susceptible to infection due to the multiplicity of invasive procedures and prolonged operating time, and the infections are often severe. The present paper reports a case control study on the economic effects of nosocomial infection in cardiac surgery. Materials
and methods
The study was undertaken in a cardiovascular surgery hospital containing three wards and 150 beds. All patients undergoing surgery between December 1986 and December 1987 were included, and data were recorded on special forms. The definitions of infection were based on those proposed by the Centers for Disease Control (1975). Correspondence Beijing, Peoples’ 019556701/90/080339+03
to: Li Liu-yi MD, Republic of China.
Department
to Epidemiology,
$03,00/O
3 Yabas
Rd,
Chaoyang
0 1990 The Hospital
339
District,
Infection
Society
L. Liu-yi
340
and W. Shu-qun
Infected cases were matched with uninfected patients in the same period using the following data: sex, underlying disease, surgical procedure, age (not more than a 3-year difference) and preoperative stay (not more than a 3-day difference). Any patient infected on admission or for whom a matched control could not be found was excluded. Control patients were rejected if their duration of postoperative stay was not at least as long as the time between operation and infection in the corresponding infected patient. Charges to patients on drugs, blood transfusions, laboratory tests, X-ray, medical care, oxygen therapy and hospital costs were recorded and analysed by the SYSTAT statistical package. Results
During the 13-month period, 1207 patients were admitted and 90 acquired an infection. The infected patients were matched with suitable controls where possible, but 11 were excluded because information on charges was lost. Suitable controls were not available for 19 cases, and these were also excluded. No significant difference was found between the 60 matched cases and controls (Table I). The additional charges for patients with nosocomial infection are shown in Table II. All were higher than controls, apart from the cost of the operation. The overall additional cost per patient was 2207 Yuan (approximately E290). The mean additional costs were particularly high in patients with multisite infections (E782) and were higher in lower respiratory tract than in postoperative wound infection. The postoperative stay was longer in all types of infection, but particularly in patients with multisite infections (Table III) Discussion
The additional costs of nosocomial infection are well known (Haley et al. 1980), but an extra 2207 Yuan (E290) is a considerable burden for Chinese families. This would be much higher if indirect costs were included.
Table
I.
The results
Mean age (years) Cases Controls * A, Patent ductus Fallot correction;
:4 arteriosus; D, prosthetic
of case and Sex
Male 30 30 B, atria1 valve
Female
control
pair
Mean preoperative stay (days)
(60
or ventricular
septal
pairs)
Type
of operation*
A
B
C
D
8 8
;i
:;
10 10
23 22
:: septal defect replacement.
matching
defect
surgery;
C, tetralogy
of
Infections Table
II.
The extra
charges
Average charge (Yuan) for infected patients (A) 1306 1397 387 87 47
Drugs Blood transfusion Lab. examinations X-rays Operation Treatment Oxygen therapy Hospitalization Total * NS, Not
in cardiac
(172) (184) (51) (11) (6)
to patients
with
infection
Extra charge (Yuan) for infected patients (E)
(67) (100) (28) (7) (6) (198)
P value
< < < <
174 (23) 32 (4) 42: (56) 70 (9) 52 (7j 2207 (290)
(81 (13) (427)
< < < <
0.001 0.001 0.001 0.05 NS* 0.01 0.001 0.001 0.001
significant.
Table
III.
Prolongation
of hospitalization
due to nosocomial Hospitalization
Type
341
nosocomial
Average charge (Yuan) for control patients (E) 509 758 213 55 47 1504 58 92 3245
144 (i9j 5452 (717)
surgery
of infection
(pairs)
Lower respiratory tract infection (27) Postoperative wound infection (17) Multisite infections (10) Other (6) Total (60)
infections
(days)
Case
Control
Difference
P value
22 26 43 19 27
12 Ei
10 14 25 1:
-c 0.01 -=c 0.01 < 0.01 < 0.01 ‘c 0.01
IO 13
A case control study is a useful method for reducing possible bias, but even with an exact match the costs were not entirely comparable, since the patients with nosocomial infection had more complications other than infection than the controls. References Centers for Disease Control (1975). National Nosocomial Infection Study Site Dejinitions Manual (unpublished). Atlanta: Centers for Disease Control. Daschner, F. D. (1984). The costs of hospital-acquired infections. Journal of Hospital Infection 5 (Suppl. A), 27. Freeman, J. et al. (1979). Adverse effects of nosocomial infection. Journal of Infectious Diseases 140, 732. Green, J. W. et al. (1977). Postoperative wound infection: A controlled study of the increased duration of hospital stay and direct cost of hospitalization. Annals of Surgery 155, 624. Haley, R. M. et aZ. (1980). Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. Journal of Infectious Diseases
141, 248.