The costs of surgical site infection after abdominal surgery in middle-income countries: Key resource use In Wound Infection (KIWI) study

M Monahan; J Glasbey; T E Roberts; S Jowett; T Pinkney; A Bhangu; D G Morton; A R de la Medina; D Ghosh; A O Ademuyiwa; F Ntirenganya; S Tabiri; NIHR Global Research Health Unit on Global Surgery

doi:10.1016/j.jhin.2023.03.023

The costs of surgical site infection after abdominal surgery in middle-income countries: Key resource use In Wound Infection (KIWI) study

J Hosp Infect. 2023 Jun:136:38-44. doi: 10.1016/j.jhin.2023.03.023. Epub 2023 Apr 21.

Authors

Collaborators

NIHR Global Research Health Unit on Global Surgery:
L A Adagrah, B B Alhaji Alhassan, M P Amoako-Boateng, A B Appiah, A Asante-Asamani, B Boakye, S A Debrah Donald Enti, R A Ganiyu, P Koggoh, R Kpankpari, I N M Opandoh, M A Manu Maison Patrick Opoku Manu, S Mensah, M T Morna, J Nkrumah, M Nortey, E O Ofori, E M Quartson, A O Acquah, L I Adam-Zakariah, E Asabre, R A Boateng, B Koomson, A Kusiwaa, E Y Twerefour James Ankomah, F Assah-Adjei, A A Boakye, G Fosu, G Serbeh, K Y Gyan, I O Nyarko, Z Robertson, D O Acheampong, J Acquaye, M Adinku, K Agbedinu, A E Agbeko, E G Amankwa, M Amoah, G Amoah, J Appiah, J Arthur, A Ayim, E K Ayodeji, J Boakye-Yiadom, E A Boateng, C Dally, A Davor, C K Gyasi-Sarpong, N N Noel Hamidu, I Haruna, N Kwarley, A K Lovi, B Nimako, B B Nyadu, D Opoku, A Osabutey, R Sagoe, S Tuffour, Y Tufour, F A Yamoah, A C Yefieye, J Yorke, K G Addo, E A Akosa, P Boakye, C L Coompson, B Gyamfi, B E Kontor, C Kyeremeh, R Manu, E Mensah, F I Solae, G K Toffah, R Adu-Brobbey, C L Coompson, A H Labaran, A Owusu, V Adobea, A Bennin, F Dankwah, S Doe, R S Kantanka, E Kobby, H Larnyor, P Y Owusu, C A Sie-Broni, M Zume, F A Abantanga, D R Abdulai, D K Acquah, E Ayingayure, I Osman, S Kunfah, G Limann, S A Mohammed, S Mohammed, Y Musah, B Ofori, E A Owusu, A H Saba, A S Seidu, S Tabiri, M Yakubu, E M Ta-Ang Yenli, K Bhatti, J Dhiman, K Dhir, D Ghosh, M Hans, P Haque, A Suroy, E D Mark Jesudason, P K, L Madankumar, R Mittal, I Nagomy, S Prasad, A Dasari, P Jacob, E Kurien, A Mathew, D Prakash, A Susan, R Varghese, R C Ortiz, G H Gonzalez, R H Krauss, L H Miguelena, M H Romero, I B Gomez, C C Aguirre, A C Avendaño, L D Sansores, H O Mejia, L U Gomez Del Campo, I D Sánchez, D G Vazquez, M M Lara, L M Perez Maldonado, A N Sainz de la Fuente, A R De la Medina, V Adeleye, A Ademuyiwa, O Adeniyi, O Akinajo, D Akinboyewa, I Alasi, F Alakaloko, O Atoyebi, O Balogun, O Belie, C Bode, A Ekwesianya, O Elebute, F Ezenwankwo, A Fatuga, G Ihediwa, A Jimoh, J Kuku, O Ladipo-Ajayi, A Makanjuola, O Mokwenyei, S Nwokocha, O Ogein, R Ojewola, A Oladimeji, T Olajide, O Oluseye, J Seyi-Olajide, A Soibi-Harry, A Ugwu, E Williams, L Abdur-Rahman, N Adeleke, M Adesola, R Afolabi, S Agodirin, I Aremu, J Bello, S Lawal, A Lawal, H Raji, O Sayomi, A Shittu

Affiliations

¹ Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. Electronic address: m.monahan.1@bham.ac.uk.
² NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, UK.
³ Health Economics Unit, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, UK.
⁴ Birmingham Surgical Trials Consortium, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
⁵ NIHR Global Health and Global Surgery Unit, Institute of Translational Medicine, Heritage Building, University of Birmingham, Birmingham, UK; Birmingham Surgical Trials Consortium, Institute of Applied Health, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
⁶ Global Surgery Research Centre, Hospital Español de Veracruz, Veracruz, Mexico.
⁷ India Hub NIHR Global Health Research Unit on Global Surgery, Ludhiana, India; Department of Anaesthesia and Surgery, Christian Medical College, Ludhiana, India.
⁸ Department of Surgery, College of Medicine and Lagos University Teaching Hospital, Lagos, Nigeria.
⁹ Department of Surgery, University of Rwanda, Kigali, Rwanda.
¹⁰ Department of Surgery, School of Medicine and Health Sciences, University for Development Studies and Tamale Teaching Hospital, Tamale, Ghana.

PMID: 37086854
DOI: 10.1016/j.jhin.2023.03.023

Abstract

Background: Surgical site infection (SSI) is the most common complication of abdominal surgery, with substantial costs to patients and health systems. Heterogeneity in costing methods in existing SSI studies makes multi-country comparison challenging. The objective of the study was to assess the costs of SSI across middle-income countries.

Methods: Centres from a randomized controlled trial assessing interventions to reduce SSI (FALCON, ClinicalTrials.gov, NCT03700749NCT) were sampled from two upper-middle- (India, Mexico) and two lower-middle- (Ghana, Nigeria) income countries. The Key resource use In Wound Infection (KIWI) study collected data on postoperative resource use and costs from consecutive patients undergoing abdominal surgery with an incision >5 cm (including caesarean section) that were recruited to FALCON between April and October 2020. The overall costs faced by patients with and without SSI were compared by operative field contamination (clean-contaminated vs contaminated-dirty), country and timing (inpatient vs outpatient).

Findings: A total of 335 patients were included in KIWI; SSI occurred in 7% of clean-contaminated cases and 27% of contaminated-dirty cases. Overall, SSI was associated with an increase in postoperative healthcare costs by 75.3% (€412 international Euros) after clean-contaminated surgery and 66.6% (€331) after contaminated-dirty surgery. The highest and lowest cost increases were in India for clean-contaminated cases (€517) and contaminated-dirty cases (€223), respectively. Overall, inpatient costs accounted for 96.4% of the total healthcare costs after clean-contaminated surgery and 92.5% after contaminated-dirty surgery.

Conclusion: SSI was associated with substantial additional postoperative costs across a range of settings. Investment in health technologies to reduce SSI may mitigate the financial burden to patients and low-resource health systems.

Keywords: Global South; Healthcare costs; Hospital acquired infections; Patient Outcomes; Postoperative complication; Wound infection.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Cesarean Section / adverse effects
Data Collection
Developing Countries*
Female
Humans
Pregnancy
Risk Factors
Surgical Wound Infection* / epidemiology
Surgical Wound Infection* / etiology
Surgical Wound Infection* / prevention & control

Associated data

ClinicalTrials.gov/NCT03700749