Skip to main content

Advertisement

SpringerLink
Log in

Socioeconomic effects of surgical site infection after cardiac surgery in Japan

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Surgical site infection (SSI) increases medical costs and prolongs hospitalization; however, there has been no multicenter study examining the socioeconomic effects of SSI after cardiovascular surgery in Japan.

Methods

A retrospective 1:1 matched, case-controlled study on hospital stay and health care expenditure after cardiovascular surgery was performed in four hospitals. Patients selected for the study had undergone coronary artery bypass grafting and/or valve surgery between April, 2006 and March, 2008. Data were obtained for 30 pairs of patients.

Results

The mean postoperative stay for the SSI group was 49.1 days, being 3.7 times longer than that for the non-SSI group. The mean postoperative health care expenditure for the SSI group was ¥2,763,000 (US$27,630), being five times higher than that for the non-SSI group. Charges for drug infusion and hospitalization for inpatient care were significantly higher for the SSI group than for the non-SSI group. The increased health care expenditure was mainly attributed to the cost of antibiotics and antimicrobial agents.

Conclusion

SSI after cardiovascular surgery not only prolonged the length of hospital stay, but also increased medical expenditure. Thus, the prevention of SSI after cardiovascular surgery is of great socioeconomic importance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250–78.

  2. Japan Nosocomial Infection Surveillance: http://www.nih-janis.jp/report/ssi.html.

  3. Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al. ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124:e652–735.

    Article  PubMed  Google Scholar 

  4. Loop FD, Lytle BW, Cosgrove DM, Mahfood S, McHenry MC, Goormastic M, et al. J. Maxwell Chamberlain memorial paper. Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity, and cost of care. Ann Thorac Surg. 1990;49:179–86.

    Article  CAS  PubMed  Google Scholar 

  5. Milano CA, Kesler K, Archibald N, Sexton DJ, Jones RH. Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival. Circulation. 1995;92:2245–51.

    Article  CAS  PubMed  Google Scholar 

  6. Stahle E, Tammelin A, Bergstrom R, Hambreus A, Nyström SO, Hansson HE. Sternal wound complications—incidence, microbiology and risk factors. Eur J Cardiothorac Surg. 1997;11:1146–53.

    Article  CAS  PubMed  Google Scholar 

  7. Borger MA, Rao V, Weisel RD, Ivanov J, Cohen G, Scully HE, et al. Deep sternal wound infection: risk factors and outcomes. Ann Thorac Surg. 1998;65:1050–6.

    Article  CAS  PubMed  Google Scholar 

  8. Ridderstolpe L, Gill H, Granfeldt H, Ahlfeldt H, Rutberg H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg. 2001;20:1168–75.

    Article  CAS  PubMed  Google Scholar 

  9. Abboud CS, Wey SB, Baltar VT. Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg. 2004;77:676–83.

    Article  PubMed  Google Scholar 

  10. Braxton JH, Marrin CA, McGrath PD, Morton JR, Norotsky M, Charlesworth DC, et al. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg. 2004;16:70–6.

    Article  PubMed  Google Scholar 

  11. Coskun D, Aytac J, Aydinli A, Bayer A. Mortality rate, length of stay and extra cost of sternal surgical site infections following coronary artery bypass grafting in a private medical centre in Turkey. J Hosp Infect. 2005;60:176–9.

    Article  CAS  PubMed  Google Scholar 

  12. Coello R, Charlett A, Wilson J, Ward V, Pearson A, Borriello P. Adverse impact of surgical site infections in English hospitals. J Hosp Infect. 2005;60:93–103.

    Article  CAS  PubMed  Google Scholar 

  13. Toumpoulis IK, Anagnostopoulos CE, Derose JJ Jr, Swistel DG. The impact of deep sternal wound infection on long-term survival after coronary artery bypass grafting. Chest. 2005;127:464–71.

    Article  PubMed  Google Scholar 

  14. Jenney AW, Harrington GA, Russo PL, Spelman DW. Cost of surgical site infections following coronary artery bypass surgery. ANZ J Surg. 2001;71:662–4.

    Article  CAS  PubMed  Google Scholar 

  15. Hollenbeak CS, Murphy DM, Koenig S, Woodward RS, Dunagan WC, Fraser VJ. The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest. 2000;118:317–402.

    Article  Google Scholar 

  16. Graf K, Ott E, Vonberg RP, Kuehn C, Haverich A, Chaberny IF. Economic aspects of deep sternal wound infections. Eur J Cardiothorac Surg. 2010;37:893–6.

    Article  PubMed  Google Scholar 

  17. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37:387–97.

    Article  PubMed  Google Scholar 

  18. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725–30.

    Article  CAS  PubMed  Google Scholar 

  19. Upton A, Smith P, Roberts S. Excess cost associated with Staphylococcus aureus poststernotomy mediastinitis. N Z Med J. 2005;118:U1316.

    PubMed  Google Scholar 

  20. Kusachi S, Kashimura N, Konishi T, Shimizu J, Kusunoki M, Oka M, et al. Length of stay and cost for surgical site infection after abdominal and cardiac surgery in Japanese hospitals: multi-center surveillance. Surg Infect (Larchmt). 2012;13:257–65.

    Article  Google Scholar 

  21. Kashimura N, Kusachi S, Konishi T, Shimizu J, Kusunoki M, Oka M, et al. Impact of surgical site infection after colorectal surgery on hospital stay and medical expenditure in Japan. Surg Today. 2012;42:639–45.

    Article  PubMed  Google Scholar 

  22. State Medicaid Director Letter # 08-004 July 31, 2008. Centers for Medicare & State Operations.

  23. Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. The Society of Thoracic Surgeons Practice Guideline Series: antibiotic prophylaxis in cardiac surgery. Part I: duration. Ann Thorac Surg. 2006;81:397–404.

    Article  PubMed  Google Scholar 

  24. Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F, et al. The Society of Thoracic Surgeons Practice Guideline Series: antibiotic prophylaxis in cardiac surgery, Part II: antibiotic choice. Ann Thorac Surg. 2007;83:1569–76.

    Article  PubMed  Google Scholar 

  25. Imai-Kawata S, Fushimi K. Factors associated with adherence to prophylactic antibiotic therapy for elective general surgery in Japan. Int J Qual Health Care. 2011;23:167–72.

    Article  Google Scholar 

  26. Gorwitz RJ, Kruszon-Moran D, McAllister SK, McQuillan G, McDougal LK, Fosheim GE, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001–2004. J Infect Dis. 2008;197:1226–34.

    Article  PubMed  Google Scholar 

  27. JANIS Annual Report 2012. http://www.nihjanis.jp/report/open_report/2011/3/1/ken_Open_Report_201100.pdf.

  28. Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, et al. Survey of infections due to staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific Region for the SENTRY antimicrobial surveillance program, 1997–1999. Clin Infec Dis. 2001;32(Suppl. 2):S-114–32.

    Article  CAS  Google Scholar 

  29. Kuwano H, Amano J, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2010: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2012;60:680–708.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the researchers who provided the required information at the medical facilities that participated in this study, and the staff responsible for medical information and administration.

Conflict of interest

This study was carried out by the Clinical Trial Committee of the Japan Society for Surgical Infection supported by Johnson & Johnson KK. None of the authors has a conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Junjiro Kobayashi & Yusuke Shimahara

  2. Department of Surgery, Medical Center, Ohashi Hospital, Toho University, Tokyo, Japan

    Shinya Kusachi

  3. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoshiki Sawa

  4. Department of Cardiac Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Noboru Motomura

  5. Department of Thoracic and Cardiovascular Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Yutaka Imoto

  6. Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan

    Haruo Makuuchi

  7. Division of Thoracic and Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan

    Kazuo Tanemoto

  8. Toho University, Tokyo, Japan

    Yoshinobu Sumiyama

Authors
  1. Junjiro Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinya Kusachi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshiki Sawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noboru Motomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yutaka Imoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Haruo Makuuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kazuo Tanemoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yusuke Shimahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yoshinobu Sumiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Junjiro Kobayashi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kobayashi, J., Kusachi, S., Sawa, Y. et al. Socioeconomic effects of surgical site infection after cardiac surgery in Japan. Surg Today 45, 422–428 (2015). https://doi.org/10.1007/s00595-014-0969-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-014-0969-2

Keywords

Search

Navigation