The Effect of Surgical Site Infection on Older Operative Patients

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Abstract
OBJECTIVES: To determine the effect of surgical site infection (SSI) on mortality, duration of hospitalization, and hospital cost in older operative patients.DESIGN: Retrospective matched‐outcomes study.SETTING: Eight hospitals, including Duke University Medical Center, and seven community hospitals.PARTICIPANTS: Patients aged 65 and older undergoing surgery from 1991 to 2003. Cases were defined as patients who developed deep incisional or organ or space SSI; controls were operative patients who did not develop SSI. Controls were frequency matched to cases according to type and year of operative procedure and to hospital in a 1:1 ratio.MEASUREMENTS: Mortality, duration of hospitalization (including re‐admissions), and hospital charges for the 90 days after surgery.RESULTS: One thousand three hundred thirty‐seven patients were enrolled in the study: 561 cases with SSI and 576 controls without SSI. In cases, the most common SSI pathogen was Staphylococcus aureus (n=275, 51.6%). Of S. aureus isolates, 58.2% were methicillin resistant. One hundred sixteen subjects died within 90 days of surgery (8.6%). In multivariable analysis, SSI was associated with greater mortality risk (odds ratio (OR)=3.51, 95% confidence interval (CI)=2.20–5.59), 2.9 times longer postoperative hospitalization (95% CI=2.61–3.13), and 1.9 times greater hospital charges (95% CI=1.78–2.10).CONCLUSION: In elderly operative patients, SSI was associated with almost 4 times greater mortality, a mean attributable duration of hospitalization after surgery of 15.7 days (95% CI=13.9–17.6) and mean attributable hospital charges of $43,970 (95% CI=$31,881–56,060).