Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital

J Hosp Infect. 2014 Jan;86(1):24-33. doi: 10.1016/j.jhin.2013.09.012. Epub 2013 Oct 16.


Background: Although surgical site infections (SSIs) are known to be associated with increased length of stay (LOS) and additional cost, their impact on the profitability of surgical procedures is unknown.

Aim: To determine the clinical and economic burden of SSI over a two-year period and to predict the financial consequences of their elimination.

Methods: SSI surveillance and Patient Level Information and Costing System (PLICS) datasets for patients who underwent major surgical procedures at Plymouth Hospitals NHS Trust between April 2010 and March 2012 were consolidated. The main outcome measures were the attributable postoperative length of stay (LOS), cost, and impact on the margin differential (profitability) of SSI. A secondary outcome was the predicted financial consequence of eliminating all SSIs.

Findings: The median additional LOS attributable to SSI was 10 days [95% confidence interval (CI): 7-13 days] and a total of 4694 bed-days were lost over the two-year period. The median additional cost attributable to SSI was £5,239 (95% CI: 4,622-6,719) and the aggregate extra cost over the study period was £2,491,424. After calculating the opportunity cost of eliminating all SSIs that had occurred in the two-year period, the combined overall predicted financial benefit of doing so would have been only £694,007. For seven surgical categories, the hospital would have been financially worse off if it had successfully eliminated all SSIs.

Conclusion: SSI causes significant clinical and economic burden. Nevertheless the current system of reimbursement provided a financial disincentive to their reduction.

Keywords: Attributable cost; Healthcare-associated infection; Length of stay; Margin (profitability); Opportunity cost; Surgical site infection.

MeSH terms

  • Costs and Cost Analysis
  • Cross Infection / economics*
  • Cross Infection / epidemiology*
  • Cross Infection / prevention & control
  • England / epidemiology
  • Hospitals
  • Humans
  • Infection Control / economics*
  • Infection Control / methods*
  • Length of Stay
  • Prevalence
  • Surgical Wound Infection / economics*
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / prevention & control