Risk and economic burden of surgical site infection following spinal fusion in adults. (24th March 2022)

• Record Type: Journal Article
• Authors: Edmiston, Charles E.; Leaper, David J.; Chitnis, Abhishek S.; Holy, Chantal E.; Chen, Brian Po-Han
• Is Part Of: Infection control and hospital epidemiology. Volume 44:Number 1(2023)
• Page Start: 88
• Page End: 95
• Publication Date: 2022-03-24
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2022.32
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract: Background: Spinal fusion surgery (SFS) is one of the most common operations in the United States, >450, 000 SFSs are performed annually, incurring annual costs >$10 billion. Objectives: We used a nationwide longitudinal database to accurately assess incidence and payments associated with management of postoperative infection following SFS. Methods: We conducted a retrospective, observational cohort analysis of 210, 019 patients undergoing SFS from 2014 to 2018 using IBM MarketScan commercial and Medicaid–Medicare databases. We assessed rates of superficial/deep incisional SSIs, from 3 to 180 days after surgery using Cox proportional hazard regression models. To evaluate adjusted payments for patients with/without SSIs, adjusted for inflation to 2019 Consumer Price Index, we used generalized linear regression models with log-link and γ distribution. Results: Overall, 6.6% of patients experienced an SSI, 1.7% superficial SSIs and 4.9% deep-incisional SSIs, with a median of 44 days to presentation for superficial SSIs and 28 days for deep-incisional SSIs. Selective risk factors included surgical approach, admission type, payer, and higher comorbidity score. Postoperative incremental commercial payments for patients with superficial SSI were $20, 800 at 6 months, $26, 937 at 12 months, and $32, 821 at 24 months; incremental payments for patients with deep-incisional SSI were $59, 766 at 6 months, $74, 875 at 12 months, and $93, 741 at 24 months. Corresponding incremental Medicare payments for patients with superficial incisional at 6, 12, 24-months were $11, 044, $17, 967, and $24, 096; while payments for patients with deep-infection were: $48, 662, $53, 757, and $73, 803 at 6, 12, 24-months. Conclusions: We identified a 4.9% rate of deep infection following SFS, with substantial payer burden. The findings suggest that the implementation of robust evidence-based surgical-care bundles to mitigate postoperative SFS infection is warranted.