Surgical site infection prevention in a local hospital setting - A cost-effectiveness analysis of a multi-modal intervention to prevent surgical site infection after hemi arthroplasty in hip fracture patients

Abstract

Background: Surgical site infections (SSI) are associated with incremental hospital costs, cause diverse clinical consequences and are detrimental to quality of life. The aim of this study was to identify risk factors of SSI, identify clinical consequences and estimate the costeffectiveness of a multi-modal intervention strategy to prevent SSI in a local hospital setting. The strategy included use of antibiotic cement, antibiotic prophylaxis and minimum two surgeons for hemi arthroplasty treatment of hip fracture. Methods: Patient level data from Bærum hospital (Norway) was analyzed to identify risk factors, clinical consequences and to estimate hospital costs. Decision analytical modeling was employed to estimate the cost-effectiveness of the intervention strategy. The analyses results and available evidence informed the input parameters of the economic model. Second order uncertainty was explored using probabilistic sensitivity analysis. Results: No risk factors of statistical significance were identified. Clinical consequences distributed unevenly between those with deep infection and those without infection were new primary hemi arthroplasties (HA), reoperations, numbers of out-patient controls and surgeries for hip infection. Mean total one year hospital costs of those with deep infection were NOK414,975, NOK275,466 for those with superficial infection and NOK228,879 for those without infection. Mean total hospital days were 25 in the deep infection group and 13 in the no infection group. These differences were significant. The economic model results indicated dominance of the multi-modal intervention strategy over the standard practice.

Background: Surgical site infections (SSI) are associated with incremental hospital costs, cause diverse clinical consequences and are detrimental to quality of life. The aim of this study was to identify risk factors of SSI, identify clinical consequences and estimate the costeffectiveness of a multi-modal intervention strategy to prevent SSI in a local hospital setting. The strategy included use of antibiotic cement, antibiotic prophylaxis and minimum two surgeons for hemi arthroplasty treatment of hip fracture. Methods: Patient level data from Bærum hospital (Norway) was analyzed to identify risk factors, clinical consequences and to estimate hospital costs. Decision analytical modeling was employed to estimate the cost-effectiveness of the intervention strategy. The analyses results and available evidence informed the input parameters of the economic model. Second order uncertainty was explored using probabilistic sensitivity analysis. Results: No risk factors of statistical significance were identified. Clinical consequences distributed unevenly between those with deep infection and those without infection were new primary hemi arthroplasties (HA), reoperations, numbers of out-patient controls and surgeries for hip infection. Mean total one year hospital costs of those with deep infection were NOK414,975, NOK275,466 for those with superficial infection and NOK228,879 for those without infection. Mean total hospital days were 25 in the deep infection group and 13 in the no infection group. These differences were significant. The economic model results indicated dominance of the multi-modal intervention strategy over the standard practice.