Search

Background: Outcome assessment after surgical treatment of intra-abdominal infections and pancreatic necrosis has concentrated on postoperative complications and survival, while long-term results have received little attention., Objectives: To evaluate hospital costs and long-term outcome for patients undergoing open treatment of intra-abdominal infection or pancreatic necrosis and to determine whether results justify costs., Design: Cohort study and cost-effectiveness analysis., Setting: Referral center., Patients: From January 1, 1988, through June 30, 1996, we used open treatment for 147 patients with pancreatic necrosis (n=75; group 1), severe intra-abdominal infections due to benign diseases (n=50; group 2), and infections due to malignant neoplasm (n=22; group 3). All surviving patients (n=92) were followed up. Fifty-seven patients in group 1, 25 patients in group 2, and 10 patients in group 3 survived., Interventions: The effective costs of treatment per surviving patient (including restorative surgery) were calculated. The patients were interviewed, and the residence location, medical treatment, degree of recovery, functional state, and employment status were assessed. We assessed the quality of life by using the short general health survey (SF-36)., Main Outcome Measures: Costs, survival, and long-term outcome., Results: The effective costs per survivor studied were $175000 (group 1) and $232400 (groups 2 and 3). Most patients experienced good long-term results, ie, employment status was unchanged for 69 (75%) of the patients, and the functional state was unchanged for 81 (88%) of the patients. Readmission to a hospital was necessary for 14 (15%) of the patients, and 5 (6%) required care in nursing homes. Of the patients studied, 75% described their quality of life as good. Patients in group 3 had significantly worse results for survival, functional status, and quality of life (P<.01, log-rank test)., Conclusions: Our study demonstrated that open treatment of severe intra-abdominal infection and pancreatic necrosis is a cost-effective treatment with good long-term results for most patients. However, patients with malignant neoplasms did not benefit from this therapy and, therefore, should not be treated by laparostomy.

We estimated costs of major postoperative infections (wound infection, 1.2%; bacteremia, 0.2%; pneumonia, 0.9%; and symptomatic urinary tract infection, 0.2%) in patients with common elective operations done in 22 community hospitals during 1985 to mid-1987 by review of 3936 medical records randomly drawn from 17,500 postoperative patients. Calculations based on observed rates of major infection by class of operation and hospitalization days beyond diagnosis related group assignments assumed that daily costs for infection management would be $750. Potential savings per 100 patients from infection control efforts was $13,230 to $47,970 for large-bowel operations, laminectomy, total hip prosthesis, other hip prosthesis, and hip fixation operations and $480 to $4455 for cholecystectomy, hysterectomy, and transurethral prostatectomy. Determination of infection surveillance and control priorities should include consideration of differences in prolongation of hospitalization among various operations by similar infections.