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Risk and economic burden of surgical site infection following spinal fusion in adults

Published online by Cambridge University Press:  24 March 2022

Charles E. Edmiston Jr Open the ORCID record for Charles E. Edmiston Jr [Opens in a new window] ,
David J. Leaper ,
Abhishek S. Chitnis Open the ORCID record for Abhishek S. Chitnis [Opens in a new window] ,
Chantal E. Holy Open the ORCID record for Chantal E. Holy [Opens in a new window]  and
Brian Po-Han Chen
Charles E. Edmiston Jr*
Affiliation:
Emeritus Professor of Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
David J. Leaper
Affiliation:
Emeritus Professor of Surgery, Department of Surgery, University of Newcastle, Newcastle-on-Tyne, UK Emeritus Professor of Clinical Sciences, Department of Clinical Sciences, University of Huddersfield, Huddersfield, UK
Abhishek S. Chitnis
Affiliation:
Medical Devices Epidemiology Division, Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
Chantal E. Holy
Affiliation:
Medical Devices Epidemiology Division, Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
Brian Po-Han Chen
Affiliation:
Health Economics and Market Access Division, Ethicon Inc., Somerville, New Jersey, USA
*
Author for correspondence: Charles E. Edmiston Jr, E-mail: edmiston@mcw.edu
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Abstract

Background:

Spinal fusion surgery (SFS) is one of the most common operations in the United States, >450,000 SFSs are performed annually, incurring annual costs >$10 billion.

Objectives:

We used a nationwide longitudinal database to accurately assess incidence and payments associated with management of postoperative infection following SFS.

Methods:

We conducted a retrospective, observational cohort analysis of 210,019 patients undergoing SFS from 2014 to 2018 using IBM MarketScan commercial and Medicaid–Medicare databases. We assessed rates of superficial/deep incisional SSIs, from 3 to 180 days after surgery using Cox proportional hazard regression models. To evaluate adjusted payments for patients with/without SSIs, adjusted for inflation to 2019 Consumer Price Index, we used generalized linear regression models with log-link and γ distribution.

Results:

Overall, 6.6% of patients experienced an SSI, 1.7% superficial SSIs and 4.9% deep-incisional SSIs, with a median of 44 days to presentation for superficial SSIs and 28 days for deep-incisional SSIs. Selective risk factors included surgical approach, admission type, payer, and higher comorbidity score. Postoperative incremental commercial payments for patients with superficial SSI were $20,800 at 6 months, $26,937 at 12 months, and $32,821 at 24 months; incremental payments for patients with deep-incisional SSI were $59,766 at 6 months, $74,875 at 12 months, and $93,741 at 24 months. Corresponding incremental Medicare payments for patients with superficial incisional at 6, 12, 24-months were $11,044, $17,967, and $24,096; while payments for patients with deep-infection were: $48,662, $53,757, and $73,803 at 6, 12, 24-months.

Conclusions:

We identified a 4.9% rate of deep infection following SFS, with substantial payer burden. The findings suggest that the implementation of robust evidence-based surgical-care bundles to mitigate postoperative SFS infection is warranted.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 1 , January 2023 , pp. 88 - 95
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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