Predictors of increased cost and length of stay in the treatment of postoperative spine surgical site infection.

BACKGROUND CONTEXT: Although many risk factors are known to contribute to the development of a postoperative surgical site infection (SSI) following spinal surgery, little is known regarding the costs associated with the management of this complication, or the predictors for which patients will require increased resources for the management of SSI.

PURPOSE: The aim of this study was to identify specific risk factors for increased treatment costs and length of stay in the management of a postoperative SSI.

STUDY DESIGN/SETTING: This is a retrospective cohort study of all patients undergoing spine surgery at a single institution for 3 consecutive years.

PATIENT SAMPLE: The study included 90 patients who were required to return to the operating room following spine surgery for postoperative SSI.

OUTCOME MEASURES: The primary outcome measure was length of stay and hospital costs for patients with postoperative SSI following spine surgery at a single institution.

METHODS: A retrospective review of all patients undergoing spine surgery at a single institution for 3 consecutive years was performed to identify patients requiring secondary surgical intervention for SSI. Demographic and financial data from both the index admission and all subsequent readmissions within 2 years of the index procedure were reviewed. Independent variables abstracted from patient records were analyzed to determine the nature and the extent of their associations with total direct hospital costs and length of stay.

RESULTS: A total of 90 patients were identified that resulted in 110 readmissions, and these patients cumulatively underwent 138 irrigation and debridement (I&D) procedures for the management of postoperative spine SSI. The average length of stay for the index operation and secondary readmissions were 6.9 and 9.6 days, respectively. The mean direct cost of the treatment for SSI was $16,242. The length of stay, the number of levels fused, methicillin-resistant Staphylococcus aureus (MRSA), decreased serum albumin on readmission, and the number of I&D procedures required were significantly associated with increased treatment costs.

CONCLUSIONS: Preoperative nutritional status assessment and MRSA colonization screening with targeted prophylaxis represent potentially modifiable risk factors in the treatment of SSI. Further study is needed to investigate the relationship between poor nutrition status and increased length of stay and total costs in the treatment of SSI following spine surgery.