Total and Attributable Costs of Surgical-Wound Infections at a Canadian Tertiary-Care Center
Total and Attributable Costs of Surgical-Wound Infections at a Canadian Tertiary-Care Center
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加拿大三级护理中心手术伤口感染的总费用和归属费用
DOI：
10.1017/s0195941700087348
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发表时间：
1998
期刊：
影响因子：
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通讯作者：
Dilini Vethanayagan
中科院分区：
文献类型：
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作者：
D. Zoutman;S. McDonald;Dilini Vethanayagan
摘要目的：确定加拿大一家教学医院的外科伤口感染的总费用和可归因费用。设计：回顾性发病率系列研究，对伤口感染的资源利用进行图表审查和检查。使用适当性评价方案（AEP）检查伤口感染住院患者的病历，AEP是一种经验证的病历审查工具，旨在确定护理的适当性，并针对伤口感染进行了修改。单位：加拿大一所大学的转诊中心。病人：病历摘录自1991年期间接受住院清洁或清洁污染手术的伤口感染患者。测量值：在伤口感染治疗期间，将所有住院日以及门诊和急诊就诊的与提供护理相关的住院费用制成表格。考虑的成本包括护理工资和福利，非医生专业服务，手术室时间，实验室，药房，用品，辅助检查和酒店费用。结果：我们确定了108例伤口感染。22名患者需要28次与伤口感染相关的外科手术。住院日共计1 116天，费用为394 337美元。进行了55次急诊和42次门诊，费用为27 193美元。通过将AEP应用于住院天数，833天或每个病例10.2天直接归因于伤口感染。伤口感染导致的住院治疗费用共计321 533美元，或每例感染3 937美元。费用分布如下：护理，51%;酒店，14%;药房，10%;实验室，9%;急诊和门诊，6%;专业服务，5%;手术室，3%;辅助检查，2%。结论：伤口感染显著增加了住院天数和相关费用。AEP方法很容易应用于确定归因的护理天数和伤口感染成本，这对于计算感染控制计划的成本效益是必要的。
ABSTRACT OBJECTIVE: To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital. DESIGN: Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections. SETTING: A university referral center in Canada. PATIENTS: Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991. MEASUREMENTS: During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs. RESULTS: We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%. CONCLUSIONS: Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.