784 Impact of Elevated Preoperative Hemoglobin A1C, Intensive Diabetes Management, and Targeted Wound Surveillance on the Incidence of Post-Discharge Surgical Site Infections Following Cardiac Surgery

2012 ◽  
Vol 28 (5) ◽  
pp. S401
Author(s):  
C. White ◽  
L. Koley ◽  
S. Christie ◽  
B. Hiebert ◽  
J. Sawatzky ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Hemoglobin A1c ◽  
Diabetes Management ◽  
Surgical Site Infections ◽  
Post Discharge ◽  
Preoperative Hemoglobin ◽  
Intensive Diabetes Management

PP275 Incorporating Quality-Of-Care Indicators In Health Economic Modelling: A Case-Study On Surgical Site Infections In Cardiac Surgery

2021 ◽  
Vol 37 (S1) ◽  
pp. 31-32
Author(s):  
Rhodri Saunders ◽  
Eleftheria Pervolaraki
Keyword(s):  
Health Economic ◽  
Cardiac Surgery ◽  
Quality Of Care ◽  
Cost Benefit ◽  
Surgical Site Infections ◽  
Cost Of Care ◽  
Economic Modelling ◽  
Post Discharge ◽  
Potential Cost

IntroductionSurgical site infections (SSIs) are preventable adverse events placing a large burden on service providers. Reusable electrocardiogram lead-and-wire systems can hold infection vectors after cleaning. Single-patient-use cable-and-lead systems (spECG) may help prevent cross-contamination and SSIs. SSIs are commonly included in incentive schemes as quality-of-care indicators. Readmissions within 30 days due to SSI are not reimbursed by the UK's National Health Service (NHS). Reducing SSIs could improve patient care and result in cost-of-care savings. The cost-benefit of implementing spECG was investigated in this study.MethodsNHS Digital 2019 data for cardiac surgeries were assessed for SSIs occurring during the index event or 90 days post discharge. Data from 88 centers performing 1,000 surgeries or more were used to update a published health economic model of the cardiac surgery care pathway. The population was on average 68 years old, 18 percent female, 33 percent obese, and 28 percent diabetic. Costs are reported in 2019 GBP (2019 EUR) and were sourced from NHS reports.ResultsIn total, 2,580 in-hospital SSIs were reported from 317,825 cardiac surgeries, resulting in an increased length-of-stay (LOS) of between 4.4 to 29.4 days. The 1,975 SSI-related, post-discharge readmissions’ mean LOS was 13.9 days. Cost-of-care was GBP8,127 (EUR9,259) per patient, in line with NHS data. Implementing spECG reduced per-case-costs to GBP8,094 (EUR9,221), saving GBP33 (EUR38): a 3.5-fold return-on-investment. Savings-drivers were fewer SSIs, reduced LOS, and fewer readmissions (a reduction of 29% within 30-days, resulting in cost-offsets of approximately GBP230 (EUR262)/readmission).ConclusionsThis study suggests that the implementation of spECG could provide cost-benefit in reducing the burden of SSIs related to cardiac surgery. In addition to cost-of-care, the readmissions would have additionally burdened hospitals, as 29 percent would not have been reimbursed. Health-economic analyses should consider not only potential cost-savings of innovative products, but also incorporate quality-of-care indicators. This further aligns payer considerations with the common end-goal of providing maximum benefit to patients.

Hyperglycemia is Associated with Surgical Site Infections among General and Vascular Surgery Patients

2017 ◽  
Vol 83 (10) ◽  
pp. 1108-1111 ◽  
Author(s):  
Amy Showen ◽  
Tara A. Russell ◽  
Stephanie Young ◽  
Sachin Gupta ◽  
Melinda M. Gibbons
Keyword(s):  
Vascular Surgery ◽  
Hemoglobin A1c ◽  
Surgical Site Infections ◽  
Glycemic Status ◽  
Preoperative Risk ◽  
Preoperative Risk Assessment ◽  
Preoperative Hemoglobin ◽  
Surgery Patient ◽  
Study Population ◽  
Peak Value

Surgical site infection (SSI) is a common cause of morbidity in general and vascular surgery patients. There is inconsistent evidence on the association of glycemic status with SSI, and its utility in predicting and mitigating SSI. General and vascular surgery patients at a public teaching hospital had the following markers of glycemic status prospectively collected: preoperative hemoglobin A1c (HbA1c) and capillary blood glucose (cBG, within six months before surgery), perioperative cBG (within 24 hours before surgery), and postoperative cBG (peak value up to 48 hours after surgery). Patient records were assessed for SSI within 30 days of surgery. Over a two-month period, 229 patients underwent surgery. The overall SSI rate was 9.6 per cent. Preoperative HbA1c >7 per cent and postoperative cBG ≥180 mL/dL occurred in 25.9 and 27.0 per cent of patients, respectively. Preoperative HbA1c >7 per cent was significantly associated with SSI [odds ratio (OR) 2.26, 80 per cent confidence interval (CI) 1.01–5.07], as was postoperative cBG ≥180 mg/dL (OR 2.12, 80 per cent CI 1.02–4.41). There was no significant correlation between preoperative or perioperative cBG and SSI. In conclusion, SSI and hyperglycemia were frequent among the study population, and positively associated. Glycemic status may be used for improved preoperative risk assessment, and as it is potentially mutable, to reduce SSI.

Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery

2017 ◽  
Vol 95 (2) ◽  
pp. 137-143 ◽  
Author(s):  
M. Reiser ◽  
A. Scherag ◽  
C. Forstner ◽  
F.M. Brunkhorst ◽  
S. Harbarth ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Surgical Site Infections

Association Between Preoperative Hemoglobin A1c, Postoperative Hyperglycemia, and Readmissions after Gastrointestinal Surgery

2016 ◽  
Vol 223 (4) ◽  
pp. S107
Author(s):  
Caroline E. Jones ◽  
Laura A. Graham ◽  
Joshua Richman ◽  
Robert H. Hollis ◽  
Tyler S. Wahl ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Gastrointestinal Surgery ◽  
Preoperative Hemoglobin
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