Incidence and Impact of Surgical Site Complications on Length of Stay and Cost of Care

Introduction: Surgical site complications (SSCs) can have serious and life-threatening consequences for patients; however, incidence rates across surgical procedures and the impact on healthcare delivery are unknown.

This study identified the incidence of wound-related SSCs in patients undergoing open surgical procedures in the United States and examined the impact of these SSCs on length of stay (LOS) and costs.

Methods: Retrospective analyses using data from Medicare (2019) and Premier (2019-2020), a national all-payer hospital database, identified patients who underwent common open surgical procedures. SSCs occurring during index hospitalization or within 90 days of discharge were identified by diagnostic related group and ICD-10 diagnosis codes. Patients with SSCs were matched to those without SSCs using propensity scoring to calculate incremental LOS and costs attributable to SSCs. The mean LOS and costs attributable to SSCs for the index admission, readmissions, and outpatient visits were summed by surgery and Charlson Comorbidity Index score to estimate the overall impact of an SSC on LOS and costs across health care settings.

Results: SSC rates were 6.7% for the 1,546,574 Medicare and 6.4% for the 781,991 Premier open surgeries. Of patients with an SSC, an estimated 23.4% of Medicare and 23.2% of Premier patients had an SSC occur during the index admission resulting in an additional 7.5 and 9 days of LOS and $10,771 and $26,433 in costs, respectively. Approximately 55.9% of Medicare and 45.1% of Premier patients with an SSC had SSC-related readmissions incurring an additional 10.9 and 8.7 days of LOS and $21,748 and $22,843 in costs, respectively.

For all patients with an SSC, the mean incremental LOS and cost per SSC, including index admission, readmissions, and costs of SSC-related outpatient visits were 7.8 days and $14,846 for Medicare patients and 6 days and $17,317 for Premier patients.

Conclusions: Wound-related SSCs persist and increase LOS and costs. Extrapolating study findings nationally results in more than 1.2 million additional hospital days and $3.4 billion in costs attributable to wound-related SSCs in patients undergoing open surgical procedures annually. Adoption of existing, evidence-based interventions that prevent SSCs are expected to decrease healthcare utilization and improve patient care.