Incidence and cost of surgical site infection following isolated coronary artery bypass graft surgery in the United States

Introduction

Surgical site infections (SSI) can be a devastating complication following cardiac surgery. In this report, using data from the National Inpatient Sample, we report the incidence and added cost of SSI following coronary artery bypass grafting (CABG).

Methods

Data was obtained through the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, National Inpatient Sample (NIS). We analyzed the 2001 to 2005 NIS public data files to determine the association of SSI with primary, isolated CABG procedures. SSI's were limited to: acute pericarditis, mediastinitis, acute osteomyelitis, chronic osteomyelitis, Infection and inflammatory reaction due to cardiac device implant or graft, Infection and inflammatory reaction due to vascular device, implant and graft, disruption of operation wound or postoperative infection.

Results

Almost 1.4 million subjects presented for primary, isolated CABG between 2001 and 2005 with 32,843 patients (2.35%) experiencing an SSI. SSI patients were significantly more likely to be female (29.1% vs. 28.5%, p<0.019), aged 75 years or greater (22.4% vs. 19.3%, p<0.001) and less likely to present for an elective procedure (41.2%, vs. 46.2%, p<0.001). A SSI significantly increased hospital stay (18.8±36.5, 8.6±12.7, p<0.001). Sixty-four percent of SSI patients experienced a LOS greater than 11 days compared to only 22% for non-SSI patients (p<0.001). In 2005, the average cost of a case involving an SSI was $63,991 ± $3,181 (Table 4). A SSI ($63,991 ± $3,181) increased average cost by 78.5% compared to non-SSI cases ($35,383 ± $1,076).

Conclusion

The incidence of surgical site infection following an isolated coronary artery bypass graft procedure substantially increases cost. With increased competition for healthcare dollars, including pay for performance, efforts to reduce infections should be redoubled.