Obese patients appear to have a significantly increased risk of developing a surgical site infection after colectomy, and the presence of infection increases the cost associated with the procedure, according to a report published online today that will appear in the September issue of Archives of Surgery, one of the JAMA/Archives journals.
Surgical site infection (SSI) is considered to be one of the best available measures of quality in surgery, and healthcare centers are starting to be financially penalized when SSI occurs, according to the authors. However, risk factors for SSI, of which the most common is obesity, are not considered in pay-for-performance models, the authors write as background information in the article.
"We chose to study colectomy as a standardized procedure because the risk of SSI following this procedure is known to be greater than that following other abdominal procedures," writes Elizabeth C. Wick, M.D., of the Johns Hopkins School of Medicine, Baltimore, and colleagues who evaluated SSI rates among obese and non-obese colectomy patients. The authors identified 7,020 patients who were between 18 and 64 years of age and who underwent either a segmental or total colectomy for colon cancer, diverticulitis or inflammatory bowel disease. Among these patients, 1,243 were identified as obese (having a body mass index greater than or equal to 30).
The overall rate of SSI was 10.3 percent, with obese patients experiencing a higher rate of SSI compared to non-obese patients (14.5 percent vs. 9.5 percent). Obesity was the strongest predictor of SSI after adjusting for laparoscopy, diagnosis, sex and age, with obese patients experiencing a 60 percent increased odds of SSI compared to non-obese patients. The average cost of colectomy was $16,399, with the average cost for obese patients approximately $295 more than that of non-obese patients. Developing a post-operative SSI was associated with increased cost of the procedure (average total cost of colectomy was $31,933 in patients with infection versus $14,608 in patients without infection), increased length of hospital stay (average of 9.5 days vs. 8.1 days), and a significantly higher rate of hospital re-admission (27.8 percent vs. 6.8 percent).