Predictors of increased cost and length of stay in the treatment of postoperative spine surgical site infection

Publication date: Available online 21 July 2017
Source:The Spine Journal
Author(s): Todd J. Blumberg, Erik Woelber, Carlo Bellabarba, Richard Bransford, Nicholas Spina
Background ContextWhile many risk factors are known to contribute to development of a post-operative surgical site infection (SSI) following spinal surgery, little is known regarding the costs associated management of this complication, or predictors for which patients that will require increased resources for management of SSI.PurposeThe aim of this study is to identify specific risk factors for increased treatment costs and length of stay in the management of a postoperative SSI.Study Design/SettingRetrospective cohort study of all patients undergoing spine surgery at a single institution over three consecutive years.Patient Sample90 patients that required return to the operating room following spine surgery for post-operative surgical site infection.Outcome MeasuresThe primary outcome measure was length of stay and hospital costs for patients with post-operative SSI following spine surgery at a single institution.MethodsA retrospective review of all patients undergoing spine surgery at a single institution between over three consecutive years was performed to identify patients requiring secondary surgical intervention for SSI. Demographic and financial data from both the index admission as well as all subsequent readmissions within two years of index procedure were reviewed. Independent variables abstracted from patient records were analyzed to determine the nature and extent of their associations with total direct hospital costs and length of stay.Results90 patients were identified that resulted in 110 readmissions and cumulatively underwent 138 I&Ds for management of postoperative spine SSI. Average length of stay for the index operation and secondary readmissions were 6.9 days and 9.6 days, respectively. Mean direct cost of treatment for SSI was $16,242. Length of stay, number of levels fused, MRSA, decreased serum albumin on readmission, and number of I&Ds required were significantly associated with increased treatment costs.ConclusionsPre-operative nutritional status assessment and MRSA colonization screening with targeted prophylaxis represent potentially modifiable risk factors in the treatment of SSI. Further study is needed to investigate the relationship between poor nutrition status and increased length of stay and total costs in the treatment of SSI following spine surgery.



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