Presentation (CTI)

OBJECTIVES: Surgical site infection (SSI) following Caesarean section (C-section) is associated with prolonged hospital stay, readmission, and increased healthcare resource use. Silver-based post-operative dressings have been associated with reduced SSI risk across surgical settings; however, the magnitude of reduction required to justify implementation in obstetric care remains uncertain. This study estimated the reduction in SSI required for enhanced post-operative wound management strategies to achieve cost neutrality and explored potential hospital cost savings following C-section in the UK.
METHODS: A decision-analytic threshold model was developed from a UK hospital perspective. Baseline SSI incidence (7.6%) and attributable inpatient cost per SSI (£3,716) were derived from published hospital surveillance and Patient Level Information and Costing System (PLICS) data. Threshold analyses estimated the minimum relative reduction in SSI required to offset incremental implementation costs (£10-£30 per patient). Scenario analyses estimated net hospital cost savings associated with relative reductions in SSI incidence ranging from 5% to 30%. Deterministic sensitivity analyses explored uncertainty in SSI incidence, attributable SSI costs, and intervention costs.
RESULTS: At a baseline SSI incidence of 7.6%, the expected hospital cost burden attributable to SSI was estimated at £282 per C-section. Assuming an intervention cost of £20 per patient, cost neutrality was achieved with a 7.1% relative reduction in SSI, corresponding to an absolute reduction of 0.54 percentage points (7.6% to 7.1%). Relative reductions of 10%, 20%, and 30% generated estimated net hospital savings of approximately £8, £36, and £65 per patient, respectively. For a hospital performing 5,000 C-sections annually, this translated to annual savings ranging from approximately £41,000 to £324,000.
CONCLUSIONS: Modest reductions in SSI following C-section may offset the incremental costs of enhanced post-operative wound management strategies, while larger reductions may generate meaningful hospital cost savings. Threshold analyses may support hospital decision-making regarding interventions associated with reduced SSI risk, including silver-based post-operative dressings.