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Abstract
BACKGROUND:
Surgical site infection (SSI) is one of the most common complications after cesarean section, and it contributes to morbidity, longer hospital stays, and significant health care costs. There is little evidence from LMICs on the economic impact of SSI after cesarean delivery. The purpose of this study was to assess the financial burden of SSI by comparing the healthcare and non-healthcare costs of women with and without postoperative SSI after cesarean section.
METHODOLOGY:
A mixed retrospective plus prospective study was done in a tertiary care hospital with 86 women who had cesarean section. Of these, 29 patients had SSI and 57 patients without SSI were used as controls. Demographic characteristics, length of hospital stay, direct medical costs (including microbiology/laboratory, medication, bed, ICU, outpatient, and re-procedure costs), and non-healthcare costs (food and attendant labor) were compared between the two groups. The Mann–Whitney U test was used for the continuous variables because the data were not normally distributed. Multivariable linear regression was used to determine independent predictors of total treatment cost. The p value of <0.05 was regarded as statistically significant.
RESULTS:
The hospital stay was significantly longer for patients with SSI than for controls (p = 0.001). In the microbiology/laboratory costs, women with SSI had significantly higher costs than the control group (p < 0.001), as did the bed costs (p = 0.001), the outpatient visit costs (p = 0.001), the attendant labor costs (p = 0.001), the food costs (p = 0.003), and the reprocedure costs (p < 0.001). There was no significant difference between the BLIS cost and medication cost. One patient had an added cost of around 765,000 rupees of ICU stay {which was calculated as around 45,000 rupees per day}. The mean total treatment cost was found to be PKR 217,198.62 ± 318,579.44 in SSI group while in control group it was PKR 73,415.61 ± 13,559.98, which is an average increase of PKR 143,783. The overall difference in total treatment cost was highly significant (Mann–Whitney U = 331.5, p < 0.001). Multivariable linear regression showed that length of stay was the only independent predictor of increased treatment cost (B = 32,797.60, p < 0.001); age and SSI status were not independently associated with total cost after adjustment.
CONCLUSION
The cost of surgical site infection after cesarean section is significant due to high cost of hospitalization and total treatment expenditure. The additional cost of SSI seems to be mostly due to longer hospital stays. Improved infection prevention measures and better perioperative care could decrease morbidity after surgery and the cost of care to the healthcare system and to patients, especially in low-resource areas.