The management and cost of surgical site infection in patients undergoing surgery for spinal metastasis

Background
Surgical site infection (SSI) is a serious potential complication of spinal surgery. SSI can impact significantly on in-patient hospitalisation and the costs associated with extra care.
Aim
To investigate the management of patients experiencing SSI following surgery for spinal metastatic tumours, and to estimate the costs associated with SSI in this context.
Methods
Patients experiencing SSI following spinal tumour surgery at a large spinal surgery centre between January 2009 and December 2012 were identified. Existing case notes were reviewed and patient and procedural data, details of the infection and treatment interventions were collected. A bottom-up approach to calculating costs associated with infection was used for patients experiencing SSI and compared with a quasi-random sample of similar patients without SSI.
Findings
The mean cost of treating patients with SSI was significantly greater than costs associated with those without SSI (p=0.019). Mean cost of in-patient hospital stay was 60% higher in patients with SSI compared to those without SSI (p=0.004). In-patient hospital stay alone accounted for 59% of total costs. Return to theatre was the second most costly intervention overall, accounting for 38% of costs, and was the most expensive single intervention involved in the treatment of SSI.
Conclusion
SSI significantly increases healthcare costs for patients undergoing surgery for spinal metastasis, with prolonged in-patient hospitalisation and return to theatre for wound management being major contributors. The actual total cost to society derived from SSI in this patient group is likely to be far beyond just the direct costs to healthcare providers.