Burden of Surgical Site Infections in The Netherlands: Cost analyses and Disability Adjusted Life Years

Abstract Background Surgical site infections (SSIs) are associated with morbidity, mortality and costs. Aim To identify the burden of (deep) SSIs in costs and Disability Adjusted Life Years (DALYs), following colectomy, mastectomy and total hip arthroplasty (THA) in the Netherlands. Methods A retrospective cost-analysis was performed using 2011 data from the national SSI surveillance network PREZIES. 62 patients with an SSI (exposed) were matched to 122 patients without SSI (unexposed, same type of surgery). Patient records were studied until one year after SSI diagnosis. Unexposed patients were followed for the same duration. Costs were calculated from the hospital perspective (2016 price level), and cost-differences were tested using linear regression analyses. Disease burden was estimated using the BCoDE toolkit of the European Center for Disease Control. The SSI model was specified per surgery-type with country- and surgery-specific parameters where possible. Findings Attributable costs per SSIs were €21,569 (THA), €14,084 (colectomy) and €1881 (mastectomy), mainly caused by prolonged length of stay. National hospital costs were estimated €10 million, €29 million, and €0.6 million respectively. National disease burden was greatest for SSIs following colectomy (3200 DALYs/year, 150 DALYs/100 SSIs), while individual disease burden was highest following THA (1200 DALYs/year, 250 DALYs/100 SSIs). For mastectomy these DALYs were below 1. Total costs of DALYs for the three surgery-types exceeded €88 million. Conclusion Depending on the type of surgery, SSIs cause a significant burden; economically as well as expressed in loss of years in full health. This underlines the importance of appropriate infection prevention and control measures.