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A Prospective Study of Outcomes, Healthcare Resource Utilization, and Costs Associated With Postoperative Nosocomial Infections

Published online by Cambridge University Press:  21 June 2016

Loreen A. Herwaldt ,
Joseph J. Cullen ,
David Scholz ,
Pamela French ,
M. Bridget Zimmerman ,
Michael A. Pfaller ,
Richard P. Wenzel  and
Trish M Perl
Loreen A. Herwaldt*
Affiliation:
Departments of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa Departments of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa University of Iowa Hospitals and Clinics, Iowa City, Iowa
Joseph J. Cullen
Affiliation:
Surgery, University of Iowa College of Medicine, Iowa City, Iowa
David Scholz
Affiliation:
Departments of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa M.B.A. Town Square Family Foot Care, Coralville, IA
Pamela French
Affiliation:
Private practice, Provincetown, MA
M. Bridget Zimmerman
Affiliation:
Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
Michael A. Pfaller
Affiliation:
Pathology, University of Iowa College of Medicine, Iowa City, Iowa Departments of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
Richard P. Wenzel
Affiliation:
Departments of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa University of Iowa Hospitals and Clinics, Iowa City, Iowa Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA
Trish M Perl
Affiliation:
Departments of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa Division of Infectious Diseases, Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD
*
C520-1 GH, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 -1081 (loreen-herwaldt@uiowa.edu)
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Abstract

Objective.

We evaluated 4 important outcomes associated with postoperative nosocomial infection: costs, mortality, excess length of stay, and utilization of healthcare resources.

Design.

The outcomes for patients who underwent general, cardiothoracic, and neurosurgical operations were recorded during a previous clinical trial. Multivariable analyses including significant covariates were conducted to determine whether nosocomial infection significantly affected the outcomes.

Setting.

A large tertiary care medical center and an affiliated Veterans Affairs Medical Center.

Patients.

A total of 3,864 surgical patients.

Results.

The overall nosocomial infection rate was 11.3%. Important covariates included age, Karnofsky score, McCabe and Jackson classification of the severity of underlying disease, National Nosocomial Infection Surveillance system risk index, and number of comorbidities. After accounting for covariates, nosocomial infection was associated with increased postoperative length of stay, increased costs, increased hospital readmission rate, and increased use of antimicrobial agents in the outpatient setting. Nosocomial infection was not associated independently with a significantly increased risk of death in this surgical population.

Conclusion.

Postoperative nosocomial infection was associated with increased costs of care and with increased utilization of medical resources. To accurately assess the effects of nosocomial infections, one must take into account important covariates. Surgeons seeking to decrease the cost of care and resource utilization must identify ways to decrease the rate of postoperative nosocomial infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 12 , December 2006 , pp. 1291 - 1298
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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