ITS 93 - Cost Burden of Spine Fusion Surgical Site Infections Using a Nationwide Claims Database

Background: Surgical Site Infections (SSIs) have been reported to occur in 0.2% to 16% of spine fusion surgeries (SFS). The Medicare population rate was reported as 8.5% in primary fusions and 12.2% in revisions over a 10-year period. We used a nationwide longitudinal database to accurately assess incidence and payments associated with management of postoperative infection following SFS.

Methods: A retrospective, observational cohort analysis involved 210,019 patients who underwent SFS from 2014 to 2018. The data was sourced from a commercial, Medicare, and Medicaid database. The primary objective of the analysis was to assess the rates of superficial/deep incisional SSIs within the specified timeframe of 3 to 180 days after surgery. This assessment was carried out utilizing Cox proportional hazard regression models. In addition to examining infection rates, the study delved into the economic implications of SSIs by evaluating adjusted payments for patients with and without SSIs. The method employed involved the use of generalized linear regression models. The combination of these analytical approaches allowed a comprehensive investigation of both the clinical and economic aspects of SSIs following SFS procedures.

Results: Among the cohort who underwent SFS from 2014 to 2018, 6.6% experienced a SSI. The rate was 1.7% for superficial and 4.9% for deep-incisional. The median time to presentation for these infections was 44 days for superficial SSIs and 28 days for deep-incisional SSIs. Payments for superficial SSIs were$20,800 at 6 months, $26,937 at 12 months, and $32,821 at 24 months. For deep SSIs, the payments were higher at $59,766 at 6 months, $74,875 at 12 months, and $93,741 at 24 months.

Conclusions: These findings underscore the economic burden associated with SSIs following SFS procedures. The risk factors and economic impact highlight the importance of preventive measures and effective management strategies to reduce both the incidence of SSIs and their associated costs.