5 The cost of surgical site infection (SSI) in hip fracture patients: a cost analysis using the Irish Hip Fracture Database

Background In line with the forecasted increase in ageing of the Irish population, the number of hip fractures is expected to rise accompanied by associated complications. This highlights the growing need of value for money based interventions which requires a robust evidence base. Currently the literature on hip fracture related SSIs is limited; the aim of this study is to quantify the direct cost of in-hospital resources used to treat a surgical site infection (SSI) post hip fracture surgery in Ireland. Methods A micro-costing methodology was conducted of the direct cost of in-patient hospital resources used to treat a post hip fracture operation SSI. Utilising patient level data from the Irish Hip Fracture Database 2023 and cost data from the Health Service Executive (HSE). Costs were estimated for each SSI patient during their hospital admission and were reported by demographic and clinical subgroups to evaluate any disparities in healthcare outcomes and expenditure. In order to contextualise the analysis, the average in-patient SSI episode cost was compared to a patient episode corresponding to a major or a minor hip fracture using Irish specific Diagnostic Related Groups (DRGs). The data collected only relates to the acute hospital admission for hip fracture and not after discharge. Results In 2023, 16 patients had developed an SSI post hip fracture surgery. The total cost of SSI for all patients was €712 898 equating to an average of €44 556 per patient; the main cost can be attributed to the prolonged length of stay within this cohort with an average of 33.9 days. No notable cost disparities were apparent between the different SSI types. However, the mean average SSI cost for males was €35 418, females was 50 039, patients aged 80 years and over €49 712 and those aged under 80 years €33 213 suggesting the presence of discrepancies between different demographic sub-groups within the cohort. Conclusions For the first time, this study provides estimates of the burden of SSI for hip fracture patients in Ireland. Spending €712 898 on 16 patients highlights that SSI imposes a significant financial burden on the Irish healthcare system. For this patient cohort Ireland has a higher average treatment cost per person for hip fracture related SSIs than other countries which have published research evidence in this area. This is due to the patients’ extended hospital length of stay which has been identified as the primary cost driver of SSI. This highlights the need to capture further data to fortify these results before their application is used to inform prevention and management of SSI.