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Impact of skin and skin structure infections on hospital length of stay, mortality and costs: a matched cohort analysis

Abstract number: P819

Akhras K.S., Lin S., Quintana A., Hatoum H.T.

Introduction: Skin and skin structure infections (SSSIs) are among the most common nosocomial infections. Given the high prevalence of SSSI infections, the potential economic impact from a health system perspective is considerable. Little is published in the literature on the impact of SSSI infections using real-world data.

Objective: To estimate excess hospital length of stay (LOS), mortality and costs attributable to SSSI.

Methods: Retrospective matched cohort study using Thomson MedSTAT data from the United States from 2001 to 2005. Patients geqslant R: gt-or-equal, slanted18 years of age, hospitalised geqslant R: gt-or-equal, slanted2 days with a secondary diagnosis of SSSI were identified using ICD-9 codes and were matched with a control cohort of non-SSSI hospitalised patients using principal diagnosis, age, gender, and admission time frame as criteria. Up to 4 matched controls were randomly selected for each eligible SSSI case. Outcomes variables were LOS, total hospitalisation charges, and mortality. Fixed effect models and conditional logistic regression were used to analyse outcomes.

Results: Among the 1,472,965 hospitalisations, 23,681 cases were identified with secondary diagnosis of SSSI and matched with 90,235 patients (control). Cellulitis/abscess was most common (66.6%) followed by surgical site infections (21.6%), osteomyelitis (8.3%) and diabetic foot infections (2.8%). Microbiologically evaluable patients accounted for 11.7% of cases. Mean and median unadjusted LOS and charges for SSSI cases were 11.4 and 8 days and $51,311 and $27,942 compared with 6.3 and 4 days and $29,883 and $16,919 for controls. Regression models on LOS and total charges to adjustment for potential confounding variables, including frequency and number of therapeutic and diagnostic procedures performed, showed that SSSI cases incurred an additional 3.81 hospital days and $14,671. Similarly, adjusted odds-ratio of mortality between cases and control was 1.31 (95% CI 1.21–1.42) indicating an increased mortality risk in hospitalised patients with SSSIs as secondary diagnoses.

Conclusion: SSSI is associated with significantly higher LOS, total charges and mortality. Given the high number of SSSI that occur annually, the burden on the health system is considerable. More effective means to prevent or to treat SSSI will most likely be cost-saving.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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