Clinical Paper
Additional direct medical costs associated with nosocomial infections after head and neck cancer surgery: a hospital-perspective analysis

https://doi.org/10.1016/j.ijom.2007.08.002Get rights and content

Abstract

The clinical impact of surgical site infections (SSI) and postoperative pneumonia (PP) after head and neck cancer surgery has been assessed in the past, but little is known about their economic impact. The present study was designed to evaluate costs related to SSI and PP after head and neck cancer surgery with opening of mucosa. The incidence of SSI and PP was measured in a prospective cohort of 261 patients who had undergone head and neck cancer surgery. The additional direct medical costs related to these infections from the hospital perspective were determined based on postoperative length of stay. The mean direct hospital costs for patients with and without SSI or PP were compared. Of the 261 patients, 81 (31%), 21 (8%) and 13 (5%) developed SSI, PP or both, respectively. The additional lengths of stay attributable to SSI, PP or both were 16, 17 and 31 days, respectively, and additional direct medical costs related to these conditions were 17,000, 19,000 and 35,000 Euros. Nosocomial infections after head and neck cancer surgery significantly increase patients’ length of stay and therefore generate additional direct medical costs. These results support the application of preventive interventions to reduce nosocomial infections in this setting.

Section snippets

Patients

This study focused on a previously reported cohort of patients with biopsy-proven squamous cell carcinoma of the upper aero-digestive tract who underwent surgery between January 1997 and December 199914, 15. Patients of this cohort enrolled in the present study had undergone the following: (i) surgery with curative intent, (ii) procedures involving a neck wound communication with the oral cavity or the oropharynx, and (iii) antibiotic prophylaxis as recommended by the French Consensus

Nosocomial infections

Of the 261 patients enrolled in this study, 94 (36%) developed a SSI and 34 (13%) a PP. The main characteristics of patients with SSI and/or PP and those without were similar (Table 1), but there was a trend towards a longer duration of procedure in patients with infection.

Additional direct medical costs attributable to nosocomial infections

The mean LOS and mean direct medical cost per patient for patients with nosocomial infections and those without are shown in Table 2. Compared to non-infected patients, SSI increased the mean LOS per patient by 16 days and

Discussion

Surgery requiring advanced technology remains the gold standard in treatment with curative intent for head and neck cancer, but leads to high postoperative morbidity, due in particular to SSI and PP12, 14, 15, 16, 19, 27. In the present study, of a cohort of 261 patients, it was estimated that SSI and PP occurred in 94 (36%) and 34 patients (13%), respectively. These estimates are consistent with those reported in other studies16, 19, 23, 27. Secondly, the mean length of stay for patients with

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    Presented in part at the 3rd World Congress of the International Federation of Head and Neck Oncologic Societies, Prague, 27 June–1 July 2006.

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