Surgical site infection risk after colorectal surgery rises with obesity
MedWire News: Surgical site infections are significantly more common after colorectal surgery if a patient is obese, research suggests, with the average costs relating to this complication running to several thousand dollars.
The researchers say that pay-for-performance policies do not take account of the increased rate of surgical site infections and cost of caring for obese patients and that this could lead to perverse incentives that penalize surgeons who take care of this patient group.
Surgical site infection rate is now considered by policy makers to be one of the best available surrogate measures of the quality of surgery, note Elizabeth Wick (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA) and colleagues.
They say: "Surgical site infections are increasingly the target of governmental and private efforts to improve quality in surgical care.
"Provisions that would cease payment for surgeons and hospitals in the event a patient develops a postoperative surgical site infection have even been proposed."
The team studied surgical site infection rates among 7020 patients who had a total or segmental colectomy for colon cancer, diverticulitis, or inflammatory bowel disease between 2002 and 2008 using administrative claims data from eight Blue Cross and Blue Shield insurance plans.
Specifically, they compared surgical site infection rates at 30 days for obese and nonobese patients and calculated total costs from all health care claims for 90 days following surgery.
The 1243 obese patients had a significantly higher rates of surgical site infection compared with nonobese patients (14.5% vs 9.5%).
Independent risk factors for these infections were obesity and having an open operation compared with a laparoscopic procedure (odds ratio=1.59 and 1.57, respectively).
The mean total cost was significantly higher for patients with infection versus those without at US$31,933 (€21,844) vs US$14,608 (€9,993).
Total length of stay was also significantly longer in patients with infection than in those without infection (mean=9.5 vs 8.1 days, respectively), as was the probability of hospital readmission (27.8% vs 6.8%).
Reporting in the Archives of Surgery, the researchers conclude: "Patients undergoing colorectal surgery who develop surgical site infections, many of whom are obese, tax the health care system.
"Pay-for-performance policies in surgery should account for the increased risk of infection and cost of caring for this population. Failure to consider these differences could lead to perverse incentives that may penalize surgeons who care for obese patients and may even affect obese patients' access to colorectal surgery."
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By Anita Wilkinson