Implementation of quality improvement initiatives have emphasized a need for reduction in hospital length of stay (LOS). Objective data identifying and evaluating risk factors for, and costs of, prolonged hospitalization in head and neck surgery are limited.
Objective: To determine the impact of surgical site infections (SSIs) on LOS and hospital costs in complex head and neck surgery, as well as identify risk factors for SSI in this population.
Review Methods: Retrospective cohort analysis of the risk-adjusted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, for years 2005-2016. Hospital per diem cost data was obtained from a tertiary Canadian hospital. Main outcomes examined were occurrence of SSI within 30 days of operation, days from surgery to discharge alive (LOS), and total hospital cost.
Data Sources: All adult patients within the multi-institutional database undergoing complex head and neck procedures (laryngectomy, pharyngo-laryngectomy, free tissue transfer) were included in analysis.
Results: All 4,026 patients identified within the database were included. 13.5% developed SSI. Adjusting for significant peri-operative risk factors and post-operative complications, SSI was found to be associated with significantly increased time to discharge alive (hazard ratio = 0.514, 95% CI [0.446-0.593], p<0.0001). Patients with SSI incurred an incremental hospital cost of 10,018.57 CAD (95% CI [5,018.45 CAD - 60,889.63 CAD]) compared to non-SSI patients.
Conclusions: SSIs were associated with significantly higher risk of prolonged hospitalization as well as increased hospitalization costs following complex head and neck surgery. These findings support SSI reduction programs for the targeted goal of institutional quality improvement.