Clinical and economic burden of surgical site infections in inpatient care in Germany: A retrospective, cross-sectional analysis from 79 hospitals

Christian Eckmann, Axel Kramer, Ojan Assadian, Steffen Flessa, Claudia Huebner, Kristian Michnacs, Christian Muehlendyck, Kim Mirjam Podolski, Michael Wilke, Wolfgang Heinlein, David John Leaper

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Surgical site infections (SSI) present a substantial burden to patients and healthcare systems. This study aimed to elucidate the prevalence of SSIs in German hospitals and to quantify their clinical and economic burden based on German hospital reimbursement data (G-DRG).

Methods
This retrospective, cross-sectional study used a 2010–2016 G-DRG dataset to determine the prevalence of SSIs in hospital, using ICD-10-GM codes, after surgical procedures. The captured economic and clinical outcomes were used to quantify and compare resource use, reimbursement and clinical parameters for patients who had or did not have an SSI.

Findings
Of the 4,830,083 patients from 79 hospitals, 221,113 were eligible. The overall SSI prevalence for the study period was 4.9%. After propensity-score matching, procedure type, immunosuppression and BMI 30 were found to significantly affect the risk of SSI (p<0.001). Mortality and length of stay (LOS) were significantly higher in patients who had an SSI (mortality: 9.3% compared with 4.5% [p<0.001]; LOS (median [interquartile range, IQR]): 28 [27] days compared with 12 [8] days [p<0.001]). Case costs were significantly higher for the SSI group (median [IQR]) €19,008 [25,162] compared with € 9,040 [7,376] [p<0.001]). A median underfunding of SSI was identified at €1,534 per patient.

Interpretation
The dataset offers robust information about the “real-world” clinical and economic burden of SSI in hospitals in Germany. The significantly increased mortality of patients with SSI, and their underfunding, calls for a maximization of efforts to prevent SSI through the use of evidence-based SSI-reduction care bundles.
Original languageEnglish
Article numbere0275970
Number of pages14
JournalPLoS One
Volume17
Issue number12
DOIs
Publication statusPublished - 28 Dec 2022

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