Investing in safe surgery could cut costs and save lives in LMICs

Investing in developing systems of safe surgery to reduce Surgical Site Infection (SSI) will help to reduce the financial burden on health services in Low- and Middle-Income Countries (LMIC), a new study reveals.

Analysing inpatient resource use in India, Ghana, Nigeria and Mexico, researchers discovered that additional investigations and hospital length of stay for a patient with an SSI compared to patient without an SSI were generally higher in clean-contaminated surgical cases compared to contaminated-dirty surgical cases.

Supported by National Institute for Health and Care Research (NIHR) funding, they found that SSI occurred in 7% of clean-contaminated cases, where wounds have no signs of infection at the time of surgery, whilst 27% of contaminated-dirty cases – where the wound encounters bodily fluids – exhibited SSI.

Overall, SSI was associated with an increase in postoperative healthcare costs by 75.3% (€412) after clean-contaminated surgery and 66.6% (€331) after contaminated-dirty surgery.

Publishing their findings in Journal of Hospital Infection, the international group of researchers, led by the University of Birmingham, reveal that the highest and lowest cost increases were in India for clean-contaminated cases (€517) and contaminated-dirty cases (€223). Overall, inpatient costs accounted for 96.4% of total healthcare costs after clean-contaminated surgery and 92.5% after contaminated-dirty surgery.

Study lead Mr Mark Monahan, from the University of Birmingham’s Institute of Applied Health Research, commented: “Surgical site infection is the world’s most common postoperative complication. This is the first multi-continental surgical cost study of its kind and reveals substantial additional postoperative costs associated with SSI across a range of settings.

“Investing in health technologies to reduce SSI could reduce this major financial burden to patients and low-resource health systems – helping to improve the overall quality of healthcare and ultimately saving lives.”

Researchers found that patients with an SSI had higher costs in both postoperative inpatient costs and post-discharge costs compared to patients without an SSI. They discovered that SSI was a statistically significant variable in determining postoperative healthcare costs.

Postoperative inpatient costs made up most of the total healthcare costs in both clean-contaminated and contaminated-dirty cases. An exploratory investigation in Ghana showed that the costs of unresolved SSI persist beyond 30 days.

The experts note that this is an important finding because 37.5% of prospective patients with an SSI were unresolved at 30 days post-surgery, potentially underestimating the true postoperative costs.

The study was part of the wider FALCON trial led by the NIHR Global Health Research Unit on Global Surgery – an initiative led by the University of Birmingham. Carried out in Benin, Ghana, India, Mexico, Nigeria, Rwanda and South Africa, FALCON evaluated measures to reduce SSI rates in patients undergoing surgery with an abdominal incision.

Patients who develop SSI experience pain, disability, poor healing with risk of wound breakdown, prolonged recovery times and psychological challenges. Those patients in LMICs are disproportionately affected by higher rates of SSI compared to those in high-income countries - increasing the risk of catastrophic expenditure, impoverishment, and wider negative community impact.

ENDS

For more information or interviews, please contact Tony Moran, International Communications Manager, University of Birmingham on +44 (0) 7827 832312. For out-of-hours enquiries, please call +44 (0) 121 414 2772.

Notes to Editors

• The University of Birmingham is ranked amongst the world’s top 100 institutions, its work brings people from across the world to Birmingham, including researchers and teachers and more than 8,000 international students from over 150 countries.
• ‘The costs of surgical site infection after abdominal surgery in middle income countries: Key resource use In Wound Infection (KIWI)’ - Mark Monahan, James Glasbey, Tracy Roberts, Sue Jowett, Tom Pinkney, Aneel Bhangu, Dion G. Morton, Antonio Ramos de la Medina, Dhruva N. Ghosh, Adesoji O. Ademuyiwa, Faustin Ntirenganya, Stephen Tabiri, on behalf of the NIHR Global Research Health Unit on Global Surgery is published by Journal of Hospital Infection.
• Participating institutions include University of Birmingham; Global Surgery Research Centre, Hospital Español de Veracruz, México; India Hub NIHR Global Health Research Unit on Global Surgery, Ludhiana, India; Christian Medical College, Ludhiana, India; College of Medicine and Lagos University Teaching Hospital, Lagos, Nigeria; University of Rwanda, Kigali, Rwanda; and University for Development Studies and Tamale Teaching Hospital, Tamale, Ghana.

About the National Institute for Health and Care Research

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

•         Funding high quality, timely research that benefits the NHS, public health and social care;

•         Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;

•         Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;

•         Attracting, training and supporting the best researchers to tackle complex health and social care challenges;

•         Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;

•         Funding applied global health research and training to meet the needs of the poorest people in low- and middle-income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low- and middle-income countries is principally funded through UK Aid from the UK government.