Want to keep the surgery bill low? Avoid surgical-site infections, study says

Subject: Geography

Section: Physical geography

Context:

Investing in safe surgeries could significantly reduce the costs associated with surgeries in low-to-middle-income countries like India, according to a study published in the Journal of Hospital Infection.

What is a surgical site infection?

A surgical site infection is a common complication in surgeries worldwide.
It is an infection that occurs at the site of a surgery in the body. It could be a superficial skin infection or a deeper one, involving tissues.
About 11% of patients who undergo surgery contract such infections.
Surgical site infections increase healthcare costs by prolonging hospital stay and by demanding more human and medical resources to treat these infections.

What did the new study do?

The researchers investigated resource costs for patients who underwent abdominal surgeries across 13 hospitals in four countries – India, Mexico, Nigeria, and Ghana – between April and October 2020.
The procedures were classified into two types:

Clean-contaminated surgeries – where surgeons cut into the gut, respiratory tract, or urinary tract in controlled sterile conditions
Contaminated-dirty surgeries – which includes accidental wounds, spillage from the gut, or a breach in the sterile conditions

The study was a part of a larger randomized controlled trial (RCT) called FALCON, which involved 57 hospitals in seven countries to investigate the effects of interventions on surgical site infections. The trial was led by the National Institute for Health and Care Research, U.K.
This is the first multi-continental surgical cost study of its kind.

Study findings:

The surgical site infections extend hospital stays up to a month or more and worsen the financial burden on patients and their families.
Surgical site infections occurred in 27% of contaminated-dirty surgeries and 7% of clean-contaminated surgeries.
The healthcare costs associated with a surgical site infection following a clean-contaminated surgery (higher by 75%) were higher than in the case of a contaminated-dirty surgery (67%).
India had the highest increase in healthcare costs associated with surgical site infections following clean-contaminated surgeries, at Rs 46,000. It also featured the lowest increase in healthcare costs for surgical site infections after contaminated-dirty surgeries, at Rs 20,000.

Did the study have any limitations?

COVID-19 pandemic.
The number of samples and surgical site infections in Mexico and Nigeria were too low to draw any general conclusions about costs.
The cost differences between different countries may have been influenced by different factors.

How can we avoid these costs?

The number of surgical site infections in India has been consistently higher than the international average.
A simple checklist of procedures like skin decontamination, adequate site marking before the surgical procedure etc., can reduce errors and morbidity.
In 2016, the WHO outlined such a checklist for surgical procedures, adhering to them with discipline could considerably lower infection incidence.
Increasing the insurance coverage and reducing the out-of-pocket expenses.

Source: TH