TY - JOUR
T1 - Use of quantile regression to determine the impact on total health care costs of surgical site infections following common ambulatory procedures
AU - Olsen, Margaret A.
AU - Tian, Fang
AU - Wallace, Anna E.
AU - Nickel, Katelin B.
AU - Warren, David K.
AU - Fraser, Victoria J.
AU - Selvam, Nandini
AU - Hamilton, Barton H.
N1 - Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2017
Y1 - 2017
N2 - Objective: To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution. Background: Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs. Methods: We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery, anterior cruciate ligament reconstruction, and hernia repair from December 31, 2004 to December 31, 2010 using commercial insurer claims data. SSIs within 90 days post-procedure were identified; infections during a hospitalization or requiring surgery were considered serious. We used quantile regression, controlling for patient, operative, and postoperative factors to examine the impact of SSIs on 180-day health care costs throughout the cost distribution. Results: The incidence of serious and nonserious SSIs was 0.8% and 0.2%, respectively, after 21,062 anterior cruciate ligament reconstruction, 0.5% and 0.3% after 57,750 cholecystectomy, 0.6% and 0.5% after 60,681 hernia, and 0.8% and 0.8% after 42,489 breast-conserving surgery procedures. Serious SSIs were associated with significantly higher costs than nonserious SSIs for all 4 procedures throughout the cost distribution. The attributable costofserious SSIs increased for both cholecystectomy and hernia repair as the quantile of total costs increased ($38,410 for cholecystectomy with serious SSI vs no SSI at the 70th percentile of costs, up to $89,371 at the 90th percentile). Conclusions: SSIs, particularly serious infections resulting in hospitalization or surgical treatment, were associated with significantly increased health care costs after 4 common surgical procedures. Quantile regression illustrated the differential effect of serious SSIs on health care costs at the upper end of the cost distribution.
AB - Objective: To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution. Background: Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs. Methods: We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery, anterior cruciate ligament reconstruction, and hernia repair from December 31, 2004 to December 31, 2010 using commercial insurer claims data. SSIs within 90 days post-procedure were identified; infections during a hospitalization or requiring surgery were considered serious. We used quantile regression, controlling for patient, operative, and postoperative factors to examine the impact of SSIs on 180-day health care costs throughout the cost distribution. Results: The incidence of serious and nonserious SSIs was 0.8% and 0.2%, respectively, after 21,062 anterior cruciate ligament reconstruction, 0.5% and 0.3% after 57,750 cholecystectomy, 0.6% and 0.5% after 60,681 hernia, and 0.8% and 0.8% after 42,489 breast-conserving surgery procedures. Serious SSIs were associated with significantly higher costs than nonserious SSIs for all 4 procedures throughout the cost distribution. The attributable costofserious SSIs increased for both cholecystectomy and hernia repair as the quantile of total costs increased ($38,410 for cholecystectomy with serious SSI vs no SSI at the 70th percentile of costs, up to $89,371 at the 90th percentile). Conclusions: SSIs, particularly serious infections resulting in hospitalization or surgical treatment, were associated with significantly increased health care costs after 4 common surgical procedures. Quantile regression illustrated the differential effect of serious SSIs on health care costs at the upper end of the cost distribution.
KW - Ambulatory surgical procedures
KW - Anterior cruciate ligament
KW - Breast-conserving surgery
KW - Cholecystectomy
KW - Costs
KW - Hernia repair
KW - Quantile regression
KW - Reconstruction
KW - Surgical site infection
UR - http://www.scopus.com/inward/record.url?scp=84973889535&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000001590
DO - 10.1097/SLA.0000000000001590
M3 - Article
C2 - 28059961
AN - SCOPUS:84973889535
SN - 0003-4932
VL - 265
SP - 331
EP - 339
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -