Colorectal Surgery is considered to have the highest Surgical Site Infection rate and is among the most expensive to treat (Tanner et al, 2009).
Whilst infection is the most common incision site complication following surgery, in some cases wound breakdown may occur as a result of other factors. This can result in wound dehiscence that requires additional treatment or surgery.
A recent study by Jenks et al (2014) reported:
- An Infection rate of 12.8% Large Bowel procedures and 9.3% Small Bowel procedures (110 surgical site infections in 932 procedures)
- Surgical Site Infections (SSI) during admission: Large Bowel procedures 6.1% and Small Bowel procedures 5.8%
- SSI on readmission: Large Bowel procedures 1.8% and Small Bowel procedures 0.4%
- Post Discharge SSI: Large Bowel procedures 4.9% and Small Bowel procedures 3.1%
Obesity and Diabetes are strongly associated with an increased risk of developing an infection (superficial/deep):
- Analysis of patients with a BMI≥30 uncovered a 48% SSI rate in this patient group (11/21)
- Patients with Diabetes Mellitus were associated with a 34.9% SSI rate
SSI are associated with considerable morbidity and contribute to additional healthcare resource use and costs. In many cases, SSI are associated with extended length of hospital stay or readmissions to manage complications (Tanner et al 2009).
In this same study from Sweden the investigators found that over 35% of patients
suffer with a post-operative complication following colorectal surgery and of these
13.9% were specifically related to wound complications (Zougas and Lydrup, 2014).
The impact of these complications can be seen in the results of this
• Reoperation in 10.4 % of patients
• Readmission rate of 7.4%
• Length of stay increased by 78%
• Failure of suture lines equated a 6-fold increase in ward costs
• Wound dehiscence or deep wound infection equated to a 4.5 fold
increase in ward costs.
The burden to the hospital is clear and complications will of course negatively
impact the patient experience as they try to recover from surgery.
NICE reports that the cost to the NHS of surgical site infections is around £700m a year based on an estimated cost per infection of £3,486.
A recent study from a single NHS trust estimated that the costs of an SSI following colorectal surgery were £4,928 for large bowel procedures and £6,198 for small bowel procedures (Jenks et al 2014). The attributable length of stay associated with the presence of an SSI was found to be 12 bed days for Small Bowel procedures and 11 bed days for Large Bowel procedures.
In many cases SSI are associated with extended length of stay both at admission and via readmission due to complications. Furthermore there may be monetary and non-monetary costs incurred by the patient, including psychosocial impacts, functional capacity, workplace costs and lost productivity.
As surgical case loads are progressively more complex and high-risk patients are increasingly common, it's more critical than ever to protect against post-operative complications.