A SYSTEMATIC REVIEW OF THE INCIDENCE AND ECONOMIC BURDEN OF SURGICAL SITE INFECTION IN KOREA

Purpose: To conduct a systematic review of literature on the epidemiological and economic burden of surgical site infection (SSI) in Korea.

Method: A literature search of the EMBASE, Medline and KoreaMed databases for English and Korean language publications was conducted. Searches for epidemiological and economic studies were conducted separately and limited to 1995–2010 to ensure the pertinence of the data. Relevant studies were identified using pre-defined criteria (i.e. reports rate, risk factors, cost of SSI; conducted in a hospital setting; not an intervention study).

Result: Twenty-five studies were included in this systematic review. The overall incidence of SSI in Korea was between 2–5%. However, the incidence varies more widely depending on the surgical procedure examined. In particular, surgeries involving the gastrointestinal tract were associated with higher rates of SSI (up to 30%). The National Nosocomial Infections Surveillance (NNIS) risk index was positively correlated with the risk of developing an SSI. Specific risk factors were identified through multivariate analyses; these included diabetes, antibiotic prophylaxis and wound classification, which were shown to increase the risk of SSI by over 100%. The pathogens more commonly associated with SSI in Korea were Pseudomonas aeruginosa and Staphylococcus aureus. SSIs are associated with increased hospitalisation cost, with each episode of SSI estimated to cost an additional ₩2,000,000. A substantial portion of the increased cost was attributed to hospital room costs and the need for additional medication. One study reported that the cost of antibiotics in patients who developed SSIs was, on average, ₩561,068 more compared to patients without SSIs. Studies also found that post-operative stays in patients with SSIs were 5 to 20 days longer, while two studies reported that following cardiac surgery, patients with SSIs spent an additional 5 to 11 days in the ICU, compared to patients without SSIs.

Conclusion: The incidence and cost estimates demonstrate that SSI represents a significant burden to the Korean healthcare system. Consequently, the identification of high-risk patient populations and the development of strategies aimed at reducing SSI could provide cost-savings and improve the efficiency of the Korean healthcare system.