OBJECTIVES : To evaluate the impact of surgical site infections on healthcare resource utilization and in-hospital costs of patients surgically treated for tibial fractures (TFs).

METHODS : A retrospective cohort study was conducted using data extracted from medical records of a Spanish university hospital. Adult patients diagnosed with a TF (isolated or polytrauma/polyfracture with tibial fracture) and surgically treated within 30 days were included. Patients were categorized into two groups based on presence or absence of post-surgical infection within 18 months following the surgical treatment for the TF. Outcomes of interest, evaluated over 18 months follow-up, were (i) hospital length of stay (LOS), (ii) ICU LOS, (iii) number of readmissions, (iv) operating room time and (v) total in-hospital costs. Official published costs were assigned to healthcare resource utilization. Generalized linear models were used to detect differences between groups while controlling for covariates.

RESULTS : 325 TF patients were identified. 62.2% were male, and most had an ASA score of 1-2 (84.9%). 20% of patients were admitted for an open fracture (Gustilo-Anderson grades were I [23; 35%], II [24; 37%] and III [18; 28%]), 12.3% were polytrauma and 20% had multiple fractures. Probability of post-surgical infection of the tibia during follow-up was 17.2%. Patients with infection had significantly adjusted higher mean LOS (34.9 vs 12.0 days; p<0.001; +191%), number of readmissions (1.2 vs 0.25; p<0.001; +380%) and mean operating room time (499 vs 219 min; p<0.001; +128%) compared to patients without infection. Mean ICU LOS was not significantly increased with infection (2.8 vs 1.7 days; p=0.17). Total in-hospital costs for patients with infection were increased from 7,607€ to 17,538€ (p<0.001; +131%).

CONCLUSIONS

: In patients surgically treated for TF, surgical site infections are associated with significantly increased healthcare resource utilization and costs over 18 months. Preventive strategies to avoid infections may generate substantial cost savings.