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The impact of surgical site infections on hospital contribution margin—a European prospective observational cohort study

Published online by Cambridge University Press:  17 October 2019

Marco von Strauss Open the ORCID record for Marco von Strauss [Opens in a new window] ,
Walter R. Marti ,
Edin Mujagic ,
Michael Coslovsky ,
Katharina Diernberger ,
Peter Hall ,
Jasmin Zeindler ,
Lilian A. Salm ,
Savas D. Soysal  and
Robert Mechera
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Marco von Strauss*
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Switzerland
Walter R. Marti
Affiliation:
Department of Surgery, Kantonsspital Aarau, Switzerland
Edin Mujagic
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland
Michael Coslovsky
Affiliation:
Clinical Trial Unit, University of Basel and University Hospital Basel, Switzerland
Katharina Diernberger
Affiliation:
Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, Scotland, United Kingdom
Peter Hall
Affiliation:
Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, Scotland, United Kingdom
Jasmin Zeindler
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland
Lilian A. Salm
Affiliation:
Department of Surgery, Kantonsspital Aarau, Switzerland
Savas D. Soysal
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Switzerland
Robert Mechera
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Switzerland
Urs von Holzen
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland Goshen Center for Cancer Care, Goshen, Indiana, United States
Walter P. Weber
Affiliation:
Department of Surgery, University of Basel and University Hospital Basel, Switzerland
*
Author for correspondence: Marco von Strauss, Email: marco.vonstrauss@clarunis.ch
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Abstract

Background:

Surgical site infections (SSIs) are common surgical complications that lead to increased costs. Depending on payer type, however, they do not necessarily translate into deficits for every hospital.

Objective:

We investigated how surgical site infections (SSIs) influence the contribution margin in 2 reimbursement systems based on diagnosis-related groups (DRGs).

Methods:

This preplanned observational health cost analysis was nested within a Swiss multicenter randomized controlled trial on the timing of preoperative antibiotic prophylaxis in general surgery between February 2013 and August 2015. A simulation of cost and income in the National Health Service (NHS) England reimbursement system was conducted.

Results:

Of 5,175 patients initially enrolled, 4,556 had complete cost and income data as well as SSI status available for analysis. SSI occurred in 228 of 4,556 of patients (5%). Patients with SSIs were older, more often male, had higher BMIs, compulsory insurance, longer operations, and more frequent ICU admissions. SSIs led to higher hospital cost and income. The median contribution margin was negative in cases of SSI. In SSI cases, median contribution margin was Swiss francs (CHF) −2045 (IQR, −12,800 to 4,848) versus CHF 895 (IQR, −2,190 to 4,158) in non-SSI cases. Higher ASA class and private insurance were associated with higher contribution margins in SSI cases, and ICU admission led to greater deficits. Private insurance had a strong increasing effect on contribution margin at the 10th, 50th (median), and 90th percentiles of its distribution, leading to overall positive contribution margins for SSIs in Switzerland. The NHS England simulation with 3,893 patients revealed similar but less pronounced effects of SSI on contribution margin.

Conclusions:

Depending on payer type, reimbursement systems with DRGs offer only minor financial incentives to the prevention of SSI.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 12 , December 2019 , pp. 1374 - 1379
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

Authors of equal contribution.

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