The Impacts Of Deep Surgical Site Infections On Readmissions, Length Of Stay, And Costs: A Matched Case-Control Study Conducted In An Academic Hospital In The Netherlands

Objective: This study aimed to evaluate the impacts of deep surgical site infections (dSSIs) regarding hospital readmissions, prolonged length of stay (LoS), and estimated costs.Patients and Methods: We designed and applied a matched case-control observational study using the electronic health records at the University Medical Center Groningen in the Netherlands. We compared patients with dSSI and non-SSI, matched on the basis of having similar procedures. A prevailing topology of surgeries categorized as clean, clean-contaminated, contaminated, and dirty was applied.Results: Out of a total of 12,285 patients, 393 dSSI were identified as cases, and 2864 patients without SSIs were selected as controls. A total of 343 dSSI patients (87%) and 2307 (81%) controls required hospital readmissions. The median LoS was 7 days (P-25-P-75: 2.5-14.5) for dSSI patients and 5 days (P-25-P-75: 1-9) for controls (p-value: < 0.001). The estimated mean cost per hospital admission was (sic) 9,016 (SE +/- 343) for dSSI patients and (sic)5,409 (SE +/- 120) for controls (p< 0.001). Independent variables associated with dSSI were patient's age >= 65 years (OR: 1.334; 95% CI: 1.036-1.720), the use of prophylactic antibiotics (OR: 0.424; 95% CI: 0.344-0.537), and neoplasms (OR: 2.050; 95% CI: 1.473-2.854).Conclusion: dSSI is associated with increased costs, prolonged LoS, and increased readmission rates. Elevated risks were seen for elderly patients and those with neoplasms. Additionally, a protective effect of prophylactic antibiotics was found.