Skip to main content
    • Aa
    • Aa

The Impact of Surgical-Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, And Extra Costs

  • Kathryn B. Kirkland (a1), Jane P Briggs (a2), Sharon L. Trivette (a2), William E. Wilkinson (a1) (a3) and Daniel J. Sexton (a1) (a2)...

To determine mortality, morbidity, and costs attributable to surgical-site infections (SSIs) in the 1990s.


A matched follow-up study of a cohort of patients with SSI, matched one-to-one with patients without SSI.


A 415-bed community hospital.

Study Population:

255 pairs of patients with and without SSI were matched on age, procedure, National Nosocomial Infection Surveillance System risk index, date of surgery, and surgeon.

Outcome Measures:

Mortality, excess length of hospitalization, and extra direct costs attributable to SSI; relative risk for intensive care unit (ICU) admission and for readmission to the hospital.


Of the 255 pairs, 20 infected patients (7.8%) and 9 uninfected patients (3.5%) died during the postoperative hospitalization (relative risk [RR], 2.2; 95% confidence interval [CI95], 1.14.5). Seventy-four infected patients (29%) and 46 uninfected patients (18%) required ICU admission (RR, 1.6; CI95,1.3-2.0). The median length of hospitalization was 11 days for infected patients and 6 days for uninfected patients. The extra hospital stay attributable to SSI was 6.5 days (CI95, 5-8 days). The median direct costs of hospitalization were $7,531 for infected patients and $3,844 for uninfected patients. The excess direct costs attributable to SSI were $3,089 (CI95, $2,139-$4,163). Among the 229 pairs who survived the initial hospitalization, 94 infected patients (41%) and 17 uninfected patients (7%) required readmission to the hospital within 30 days of discharge (RR, 5.5; CI95, 4.0-7.7). When the second hospitalization was included, the total excess hospitalization and direct costs attributable to SSI were 12 days and $5,038, respectively.


In the 1990s, patients who develop SSI have longer and costlier hospitalizations than patients who do not develop such infections. They are twice as likely to die, 60% more likely to spend time in an ICU, and more than five times more likely to be readmitted to the hospital. Programs that reduce the incidence of SSI can substantially decrease morbidity and mortality and reduce the economic burden for patients and hospitals.

Corresponding author
Box 3306, Duke University Medical Center, Durham, NC 27710
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

4. KB Poulsen , CH Wachmann , A Bremmelgaard , AI Sorensen , D Raahave , JV Petersen . Survival of patients with surgical wound infection: a case-control study of common surgical interventions. Br J Surg 1995;82:208209.

5. SKR Clarke . Sepsis in surgical wounds with particular reference to Staphylococcus aureus. Br J Surg 1957;44:592596.

7. J Loewenthal . Sources and sequelae of surgical sepsis. BMJ 1962;1:14371440.

10. J Freeman , BA Rosner , J McGowan Jr. Adverse effects of nosocomial infection. J Infect Dis 1979;140:732740.

12. TC Horan , RP Gaynes , WJ Martone , WR Jarvis , TG Emori . CDC definitions of nosocomial surgical site infections, 1992: a modification of CD. definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606608.

13. TG Emori , DH Culver , TC Horan , WR Jarvis , JW White , DR Olson , et al. National Nosocomial Infections Surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:1935.

14. DH Culver , TC Horan , RP Gaynes , WJ Martone , WR Marvis , TG Emori , et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91(suppl 3B):152S157S.

18. TH Holtz , R Wenzel . Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control 1992;20:206213.

19. K Sands , G Vineyard , R Platt . Surgical site infections occurring after hospital discharge. J Infect Dis 1996;173:963970.

20. RB Brown , S Bradley , E Opitz , D Cipriani , R Pieczarka , M Sands . Surgical wound infections documented after hospital discharge. Am J Infect Control 1987;15:5458.

21. DJ Byrne , W Lynch , A Napier , P Davey , M Malek , A Cuschieri . Wound infection rates: the importance of definition and post-discharge wound surveillance. J Hosp Infect 1994;26:3743.

22. RW Haley . Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991;91(suppl 3B):32S38S.

23. P Davey , C Hernanz , W Lynch , M Malek , D Byrne . Human and non-financial costs of hospital-acquired infection. J Hosp Infect 1991;18(suppl A):7984.

25. RP Wenzel . Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control: economic implications for hospitals under the prospective payment system. Am J Med 1985;78(suppl B):37.

26. RW Haley , JW White , DH Culver , JM Hughes . The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system: an empirical determination from a nationally representative sample. JAMA 1987;257:16111614.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 28 *
Loading metrics...

Abstract views

Total abstract views: 1235 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd May 2017. This data will be updated every 24 hours.