TY - JOUR
T1 - The effect of surgical site infections on outcomes and resource utilization after liver transplantation
AU - Hollenbeak, Christopher S.
AU - Alfrey, Edward J.
AU - Souba, Wiley W.
PY - 2001
Y1 - 2001
N2 - Background. Although postoperative infections have a significant impact on morbidity and mortality after orthotopic liver transplantation (OLT), less is known about their economic implications. In this study, we sought to identify risk factors and estimate the impact of surgical site infections on 1-year mortality, graft survival, and resource utilization after OLT. Methods. We studied 777 first, single-organ liver transplant recipients from the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. Surgical site infections (n = 292, 37.8%) were defined as bacterial or fungal infections of the liver, intestine, biliary tract, surgical wound, or peritoneum within 1 year of transplantation. A subset of these (n = 159) occurred during the transplant hospitalization and were used to estimate excess charges associated with surgical site infections. Results. Leaks in the choledochojejunostomy (odds ratio [OR] = 7.1, P = .001) and choledochocholedochostomy (OR = 2.5, P = .002), extended operation duration in hours (OR = 1.2, P = .002), serum albumin levels in grams per liters (OR = 0.71, P = .009), ascites (OR = 1.43, P = .037), and administration of OKT3 within 7 days (OR = 1.49, P = .039) significantly increased risk of infection. Surgical site infections did not significantly increase 1-year mortality (88.5% vs 91.5%, P = .19) but significantly increased 1-year graft loss (79.8% vs 86.5%, P = .022). Patients with surgical site infections incurred approximately 24 extra hospital days and $159,967 in excess charges (P = .0001). Multivariate analysis reduced the estimate of excess charges to $131,276 (P = .0001). Conclusions. Liver transplant recipients who develop surgical site infection have significantly higher resource utilization requirements than those who do not. These results imply substantial returns to preventative efforts directed at surgical site infections in patients undergoing OLT.
AB - Background. Although postoperative infections have a significant impact on morbidity and mortality after orthotopic liver transplantation (OLT), less is known about their economic implications. In this study, we sought to identify risk factors and estimate the impact of surgical site infections on 1-year mortality, graft survival, and resource utilization after OLT. Methods. We studied 777 first, single-organ liver transplant recipients from the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. Surgical site infections (n = 292, 37.8%) were defined as bacterial or fungal infections of the liver, intestine, biliary tract, surgical wound, or peritoneum within 1 year of transplantation. A subset of these (n = 159) occurred during the transplant hospitalization and were used to estimate excess charges associated with surgical site infections. Results. Leaks in the choledochojejunostomy (odds ratio [OR] = 7.1, P = .001) and choledochocholedochostomy (OR = 2.5, P = .002), extended operation duration in hours (OR = 1.2, P = .002), serum albumin levels in grams per liters (OR = 0.71, P = .009), ascites (OR = 1.43, P = .037), and administration of OKT3 within 7 days (OR = 1.49, P = .039) significantly increased risk of infection. Surgical site infections did not significantly increase 1-year mortality (88.5% vs 91.5%, P = .19) but significantly increased 1-year graft loss (79.8% vs 86.5%, P = .022). Patients with surgical site infections incurred approximately 24 extra hospital days and $159,967 in excess charges (P = .0001). Multivariate analysis reduced the estimate of excess charges to $131,276 (P = .0001). Conclusions. Liver transplant recipients who develop surgical site infection have significantly higher resource utilization requirements than those who do not. These results imply substantial returns to preventative efforts directed at surgical site infections in patients undergoing OLT.
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U2 - 10.1067/msy.2001.116666
DO - 10.1067/msy.2001.116666
M3 - Article
C2 - 11490376
AN - SCOPUS:0034900927
SN - 0039-6060
VL - 130
SP - 388
EP - 395
JO - Surgery
JF - Surgery
IS - 2
ER -
