OBJECTIVES

Despite antibiotic prophylaxis, post-coronary artery bypass graft (CABG) surgical site infections (SSIs) and sternal wound infections (SWIs), add substantially to healthcare costs. Here we estimate the burden of SSIs in Brazil, Canada, Chile, Mexico, and the United States (US).

METHODS

A 1-year Markov-model representing the care pathway for CABG was created and populated with data from peer-reviewed literature and national surveillance programs. The focus was on the healthcare systems of the Americas with data on CABG and SWIs rates. Key parameters included: CABG procedures per year, surgical site infection (SSI) rates, ratio SSIs to SWIs, length of stay, hospital time to treat SWIs, and the cost per day of intensive care unit (ICU) and general ward. The model estimated the per country economic burden of CABG-related SSIs. Model results were used to calculate the incremental cost change that could be justified by an intervention that reduces cross-contamination risk and associated SSI rate by 1 event per 100 procedures. Missing data was imputed based on data from other countries. All cost estimates were calculated in 2017 US dollars (USD).

RESULTS

For the selected countries the burden of CABG-related SSIs included 21,630 additional ICU days, 107,755 additional ward days, and an extra 6,340 hospital readmissions. The total cost burden exceeded $381 million, with a mean cost of a CABG-related SSI for Brazil, Canada, Chile, Mexico, and the US was $6,123; $17,606; $7,325; $7,733; and $28,157, respectively. A technology that can reduce the rate of SSIs by 1 per 100 procedures could justify an incremental cost of $50 in Brazil and $211 in the US.

CONCLUSIONS

The burden of post-CABG SSIs is substantial. Incorporating a technology into the broader HAI-prevention bundle that reduces the risk of cross-contamination and associated SSIs may be a cost-effective investment.