The Burden of Sternal Wound Infections Following CABG
A Costly Challenge for European Healthcare
Introduction
Sternal wound infections (SWIs) pose a significant risk following coronary artery bypass graft surgery (CABG) and can lead to complex surgical-site infections (SSIs). A recent study aimed to capture the cost burden of SWIs in European countries, shedding light on the impact of these infections on healthcare budgets. This blog will delve into the findings of the study and discuss the importance of reducing SWI burden for both patients and healthcare providers.
Understanding the Study
The study utilized a standardized care pathway for CABG, modeling the incidence and cost of SWIs. Markov modeling was employed to calculate the cost burden from a hospital perspective, considering intensive-care-unit (ICU) and general-ward (GW) days as the primary cost factors. Data from Eurostat and peer-reviewed literature were used to establish the input parameters. The analysis included 26 European countries, with varying levels of data availability.
The Cost Burden of SWIs
Among the countries analyzed, the median incidence of SWIs following CABG was 3.9% (2.9-5.6%). The total burden for all 26 countries amounted to €170.8 million, encompassing additional ICU days, GW days, and readmissions. The cost of an SWI ranged from €8,924 in Poland to €21,321 in Denmark. Relative to the costs of post-CABG care without SWI complications, the incremental cost of an SWI was highest in Greece (24.9% increase) and lowest in the UK (3.8% increase). The median increase across all countries was 12% (10-16%).
Variation in SWI Rates and Costs
The study revealed substantial variation in SWI rates and costs among the analyzed countries. Incidence rates ranged from 1.6% to 10.4%, depending on the country and time frame. Additionally, the proportion of deep SWIs (DSWIs) varied, with Hungary reporting the highest percentage (76%) and Iceland reporting the lowest (23.3%). The cost burden varied in accordance with population size, with Germany experiencing the highest annual cost of €31.7 million, while Malta had the lowest at €54,410. Normalized by the number of CABG procedures, the Netherlands had the highest cost burden, while the UK had the lowest.
The Need for SWI Reduction
Despite a decrease in SSI rates in recent years, SWIs remain a significant burden on European healthcare systems. SWIs were found to increase the cost of post-CABG care by 10-16%, despite occurring in only 2.9-5.6% of procedures. Therefore, there is an urgent need to reduce the burden of SWIs and improve care for cases that still occur. Examples of successful interventions, such as improved infection control and surveillance methods, have demonstrated significant reductions in SSI rates.
Innovative Approaches and Value-Based Purchasing
Innovative approaches to reducing SWI burden can benefit both patients and healthcare budgets. While new technology may increase per-procedure costs, it can lead to downstream savings by reducing SWI-related expenses. Implementing systems that hold hospitals accountable for avoidable SSIs, such as in the UK, can incentivize improved infection control. Value-based purchasing agreements, which allow hospitals to limit upfront costs until proof of benefit is determined, can be advantageous for hospitals and suppliers alike.
Conclusion
SWIs, particularly DSWIs, continue to present a considerable challenge post-CABG. The treatment, prolonged hospital stays, and readmissions associated with SWIs significantly increase the cost of care, placing a burden on healthcare budgets. To improve patient outcomes and alleviate financial strain, it is crucial to prioritize interventions that reduce SWI rates. Value-based purchasing schemes and innovative approaches to infection control can play a vital role in mitigating the risk and cost of SWIs, benefiting both patients and healthcare providers in the long run.
Link to study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645249/#
