Nationwide Burden and Hospital Costs of Surgical Site Complications in France: A Retrospective Analysis of the French National PMSI Administrative Database

IntroductionSurgical site complications (SSCs) such as surgical site infections (SSIs) cause significant morbidity and mortality for patients and raise costs. Our goal was to estimate the frequency and cost of SSCs (including SSIs) in France for orthopedic, cardiac, digestive (gastrointestinal), and bariatric surgeries including costs of index admission and readmissions due to SSCs.MethodsWe used a national hospital database and included the prevalence of SSCs for patients admitted in 2018. Patients were categorized by type of SSC (infection related to surgery; infection associated to surgery; non-infectious complication; no complication related to the surgical incision). Cost, length of stay, and readmission data was analyzed using the French Diagnostic Related Groups (DRG), Groupements Homogènes de Séjours (GHS).ResultsEstimated SSIs rates ranged from 0.44% in orthopedic to 3.09% in digestive surgery. Cardiac surgery had the highest rate of overall complications (14.91%), of which 89.26% were non-infectious. Cardiac surgery SSCs had the highest rates of readmissions (from 3.6% at 30 days to 9.9% at 365 days) while orthopedic surgery SSCs had the lowest (1.5% and 4.1% respectively). The overall economic impact of SSIs in additional length of stay ranged from 11.1 to 28.1 days, and from 6,622 to 22,109 euros for costs. Considering the general population receiving surgery for these specialties in 2018, the added expense for payers due to readmissions related to SSCs reached approximately 840 M€.ConclusionThe occurrence of an SSC generates a financial burden to the care organization. New indicators may support better control of SSCs.