Erika D Sears1, Lizi Wu2, Jennifer F Waljee2, Adeyiza O Momoh2, Lin Zhong2, Kevin C Chung2. 1. Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, 48109-5340, USA. endavis@med.umich.edu. 2. Department of Surgery, Section of Plastic Surgery, The University of Michigan Health System, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, 48109-5340, USA.
Abstract
BACKGROUND: Recent national infection control efforts have been directed at reducing postsurgical infection rates, related morbidity, and cost. We sought to evaluate population-level rates of deep sternal wound infection (DSWI) after cardiac surgery, associated mortality, and resource use compared to patients undergoing cardiac surgery without postoperative DSWI relative to historical trends. METHODS: We analyzed the MarketScan ® Commercial Claims Databases from 2009 to 2013 to identify adult patients who developed DSWI after open cardiac surgery. Patients with and without DSWI were compared. The outcomes of interest included 30-day, 90-day, and 1-year in-hospital mortality. Utilization outcomes, including total hospital days and inpatient costs, were calculated in the time period from the index cardiac surgery through 90 days after DSWI diagnosis. RESULTS: In this cohort, 176,537 patients underwent one or more cardiac surgery procedures. DSWI occurred in 2835 (1.6 %) patients. One-year mortality for patients with DSWI was 10.7 versus 2.5 % (P < 0.001) in patients without DSWI. Mean hospital days in patients with DSWI were 33 versus 9 days for patients without DSWI (P < 0.001). Mean cost for patients with DSWI was greater than 2.5 times that of patients without DSWI ($211,478 vs $82,089, P < 0.001). CONCLUSIONS: Treatment of DSWI results in substantial morbidity, mortality, and excess cost for treating facilities. The rates of DSWI have not decreased dramatically over the last 10-20 years. Thus, more attention needs to be focused toward understanding treatment variation that exists in patients diagnosed with DSWI.
BACKGROUND: Recent national infection control efforts have been directed at reducing postsurgical infection rates, related morbidity, and cost. We sought to evaluate population-level rates of deep sternal wound infection (DSWI) after cardiac surgery, associated mortality, and resource use compared to patients undergoing cardiac surgery without postoperative DSWI relative to historical trends. METHODS: We analyzed the MarketScan ® Commercial Claims Databases from 2009 to 2013 to identify adult patients who developed DSWI after open cardiac surgery. Patients with and without DSWI were compared. The outcomes of interest included 30-day, 90-day, and 1-year in-hospital mortality. Utilization outcomes, including total hospital days and inpatient costs, were calculated in the time period from the index cardiac surgery through 90 days after DSWI diagnosis. RESULTS: In this cohort, 176,537 patients underwent one or more cardiac surgery procedures. DSWI occurred in 2835 (1.6 %) patients. One-year mortality for patients with DSWI was 10.7 versus 2.5 % (P < 0.001) in patients without DSWI. Mean hospital days in patients with DSWI were 33 versus 9 days for patients without DSWI (P < 0.001). Mean cost for patients with DSWI was greater than 2.5 times that of patients without DSWI ($211,478 vs $82,089, P < 0.001). CONCLUSIONS: Treatment of DSWI results in substantial morbidity, mortality, and excess cost for treating facilities. The rates of DSWI have not decreased dramatically over the last 10-20 years. Thus, more attention needs to be focused toward understanding treatment variation that exists in patients diagnosed with DSWI.
Authors: Evan Matros; Sary F Aranki; Lauren R Bayer; Siobhan McGurk; Jennifer Neuwalder; Dennis P Orgill Journal: J Thorac Cardiovasc Surg Date: 2009-12-16 Impact factor: 5.209
Authors: Denis A Berdajs; Andrej Trampuz; Enrico Ferrari; Patrick Ruchat; Michel Hurni; Ludwig K von Segesser Journal: Interact Cardiovasc Thorac Surg Date: 2011-03-03
Authors: Charles E Edmiston; Maureen Spencer; Brian D Lewis; Kellie R Brown; Peter J Rossi; Cindy R Henen; Heidi W Smith; Gary R Seabrook Journal: Surg Infect (Larchmt) Date: 2011-07-18 Impact factor: 2.150
Authors: B Zane Atkins; Mark W Onaitis; Kelley A Hutcheson; Keith Kaye; Rebecca P Petersen; Walter G Wolfe Journal: Am J Surg Date: 2011-09-14 Impact factor: 2.565
Authors: Jonah J Stulberg; Conor P Delaney; Duncan V Neuhauser; David C Aron; Pingfu Fu; Siran M Koroukian Journal: JAMA Date: 2010-06-23 Impact factor: 56.272
Authors: Jayant P Agarwal; Michael Ogilvie; Liza C Wu; Robert F Lohman; Lawrence J Gottlieb; Mietka Franczyk; David H Song Journal: Plast Reconstr Surg Date: 2005-09-15 Impact factor: 4.730
Authors: Hanadi Al Salmi; Ahmed Elmahrouk; Amr A Arafat; Azzahra Edrees; Mashael Alshehri; Ghassan Wali; Ibrahim Zabani; Nasser A Mahdi; Ahmed Jamjoom Journal: J Int Med Res Date: 2019-03-21 Impact factor: 1.671
Authors: Carmel L Montgomery; Nguyen X Thanh; Henry T Stelfox; Colleen M Norris; Darryl B Rolfson; Steven R Meyer; Mohamad A Zibdawi; Sean M Bagshaw Journal: CJC Open Date: 2020-09-14