The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: Adverse quality of life, excess length of stay, and extra cost
The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: Adverse quality of life, excess length of stay, and extra cost
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DOI：
10.1086/502033
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发表时间：
2002-04-01
影响因子：
4.5
通讯作者：
Sexton, DJ
中科院分区：
文献类型：
--
作者：
Whitehouse, JD;Friedman, D;Sexton, DJ
目的：衡量骨科手术部位感染 (SSI) 对生活质量、住院时间和费用的影响。设计：队列中的配对 (1:1) 病例对照研究。地点：三级护理大学医疗中心和社区医院。患者：骨科 SSI 病例由感染控制专业人员前瞻性识别。匹配的对照是从没有 SSI 的接受骨科手术的整个患者队列中选择的。匹配变量包括手术类型、国家医院感染监测风险指数、年龄、手术日期和外科医生。 主要观察指标：生活质量、术后住院时间、再入院频率、总体直接医疗费用和死亡率。 结果：确定了 59 例 SSI。每个骨科 SSI 导致初始住院期间中位数额外住院 1 天 (P = .001) 和随访期间额外住院天数中位数 14 天 (P = .0001)。 SSI 患者需要更多的再住院次数（中位数为 2 vs 1；P = .0001）和更多的总外科手术次数（中位数为 2 vs 1；P = .0001）。每个感染患者的平均住院总直接费用为 24,344 美元，而每个未感染患者的住院费用为 6,636 美元 (P = .0001)。病例和对照的死亡率相似。 SSI 患者的生活质量受到不利影响。医疗结果研究简表 36 问卷的分数下降幅度最大的是身体机能和角色身体领域。结论：骨科 SSI 使每位患者的总住院时间平均延长 2 周，再住院率大约翻倍，并使医疗费用增加 300% 以上。此外，患有骨科 SSI 的患者具有更大的身体限制，并且其健康相关的生活质量显着下降（Infect Control Hosp Epidemiol 2002；23：183-189）。
OBJECTIVE: To measure the impact of orthopedic surgical-site infections (SSIs) on quality of life, length of hospitalization, and cost.DESIGN: A pairwise-matched (1:1) case-control study within a cohort.SETTING: A tertiary-care university medical center and a community hospital.PATIENTS: Cases of orthopedic SSIs were prospectively identified by infection control professionals. Matched controls were selected from the entire cohort of patients undergoing orthopedic surgery who did not have an SSI. Matching variables included type of surgical procedure, National Nosocomial Infections Surveillance risk index, age, date of surgery, and surgeon.MAIN OUTCOME MEASURES: Quality of life, duration of postoperative hospital stay, frequency of hospital readmission, overall direct medical costs, and mortality rate.RESULTS: Fifty-nine SSIs were identified. Each orthopedic SSI accounted for a median of 1 extra day of stay during the initial hospitalization (P = .001) and a median of 14 extra days of hospitalization during the follow-up period (P = .0001). Patients with SSI required more rehospitalizations (median, 2 vs 1; P = .0001) and more total surgical procedures (median, 2 vs 1; P = .0001). The median total direct cost of hospitalizations per infected patient was $24,344, compared with $6,636 per uninfected patient (P = .0001). Mortality rates were similar for cases and controls. Quality of life was adversely affected for patients with SSI. The largest decrements in scores on the Medical Outcome Study Short Form 36 questionnaire were seen in the physical functioning and role-physical domains.CONCLUSIONS: Orthopedic SSIs prolong total hospital stays by a median of 2 weeks per patient, approximately double rehospitalization rates, and increase healthcare costs by more than 300%. Moreover, patients with orthopedic SSIs have substantially greater physical limitations and significant reductions in their health-related quality of life (Infect Control Hosp Epidemiol 2002;23:183-189).