Surgical Road Map for Healthcare Welfare in Low- And Middle-Income Countries

An exploratory investigation in Ghana revealed that surgical site infection was a statistically significant variable in determining postoperative healthcare costs.

Introducing systems that ensure safe surgery can reduce Surgical Site Infection (SSI). This will help to reduce the financial burden on health services in Low- and Middle-Income Countries (LMIC), reveals a new study published in Journal of Hospital Infection.

The study was part of the trial led by the NIHR Global Health Research Unit on Global Surgery – an initiative led by the University of Birmingham. It was carried out in Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa.

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Hospital acquired infections (HAI) are acquired by patients and health personnel alike in a hospital setting. HAI can be life-threatening and need to be promptly diagnosed and treated. Major causes are bacteria, with fungi and viruses playing a lesser role.

‘Investing in health technologies that reduce surgical site infection could improve the overall quality of healthcare and ultimately save lives.’

The main of the study was to evaluate the effectiveness of measures taken for reducing surgical site infection (SSI) rates in patients undergoing surgery with an abdominal incision.

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process ().

It is the world’s most common postoperative complication that can sometimes be superficial infections involving the skin only or more seriously involving tissues under the skin, organs, or implanted material.

Impact of Surgical Site Infection on Healthcare Costs and Patient Outcomes

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.

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

They revealed 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 ().

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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.

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.

Simple, Cost-Effective Way to Reduce Surgical Site Infection
The prevalence of surgical site infection is reduced by 13% by changing gloves and surgical equipment before wound closure.

Researchers also found that patients with an SSI had higher costs in both postoperative inpatient costs and post-discharge costs compared to patients without an SSI. Postoperative inpatient costs made up most of the total healthcare costs in both clean-contaminated and contaminated-dirty cases. In Ghana, 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.

Patients who develop SSI experience pain, disability, poor healing with risk of wound breakdown, prolonged recovery times, and psychological challenges.

Those patients in Low- And Middle-Income Countries (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.

References:

Surgical Site Infection Prevention - A Review - (https://jamanetwork.com/journals/jama/article-abstract/2800424)
The costs of surgical site infection after abdominal surgery in middle-income countries: Key resource use In Wound Infection (KIWI) study - (https://www.journalofhospitalinfection.com/article/S0195-6701(23)00114-7/fulltext)

Source-Medindia