SSIs Are Not Minor Short-term Problems, They're Major Long-term Burdens

During the entirety of my medical career, rarely have I come across a healthcare burden as grossly underestimated as surgical site infections (SSIs). They’re often thought of as an acute event with minimal impact on the long-term quality of a patient’s life, on mortality and on cost. Unfortunately, this is not true. SSIs are not simply a minor problem that can be easily treated with antibiotics, and therefore cause only a minor delay to the recovery process. In fact, they can have a detrimental impact on long-term survival, morbidity rates, and financial burden on healthcare systems.

Recent evidence collected in different countries, and for different pathologies, suggest that even SSIs that are treated effectively can have a detrimental impact on long-term survival. A Canadian study looked at over 14,000 patients between 2010 and 2015 and revealed that patients who contracted an SSI had a higher rate of hospital readmission, and increased mortality during the first year after surgery, compared to patients who did not develop an SSI. Another study conducted on the Veteran Administration database, where over 600,000 records were analysed, showed that an SSI increases the likelihood of a subsequent infection and mortality up to a year after surgery.

Many of my medical peers recognise that the national audit systems are underestimating the size of the problem, especially the so-called “post-discharge blind spot”. Surgeons often don’t become aware of the SSI, as post-discharge complications are often referred to primary care where GPS treat them.

Then there is the cost impact. It’s not surprising that the use of healthcare resources increases for patients who have a complication during surgery. Our healthcare services are already burdened by a discrepancy between resources and demand, and SSIs do nothing to relieve this burden. In fact, SSIs represent a major economic issue for healthcare providers and can even cause a loss of reputation. Contracting an SSI can extend a patient’s hospital stay by an average of 9.8 day  and the cost of an SSI is estimated to be in the proximity of 2,000 EUR – 4,000 EUR per patient.

In terms of cost to patient, they will often suffer delayed wound healing and the need for additional surgery and prolonged hospital cases. In some cases, even death.

So, what is the path forward to reduce the burden of surgical site infection? Although I don’t see one single solution to the problem, there is clinical evidence that points to implementing surgical care bundles that include the use of triclosan-coated antibacterial sutures to support reducing the risk of SSIs, like this brilliant example at Oxford University Hospitals NHS Foundation Trust.

But SSI prevention isn’t just beneficial to the patient. Recent research presented at The International Society of Pharmaeconomic, and Outcomes Research (ISPOR) conference showed that SSIs were associated to an additional 10 days in hospitals, 4.1 additional outpatient appointments, and 22% more A&E visits compared with patients without SSIs. Due to the additional resources required, the analysis demonstrated reducing one SSI could save 0.58 tonnes of CO2e (equivalent to two return flights from London to Rome), 5m of direct water use and 0.06 tonnes of waste. The annual cost to NHS England of SSI-associated environmental impact was estimated to be £2.67million

All of this amounts to the reality that SSIs have a long-term impact on the survival of patients and investing in optimised bundles of care and proven technological solutions can help minimise this risk. We need clinicians and healthcare managers to invest their time and resources now more than ever to help save more lives.