Environmental and financial cost of surgical-site infection by severity after lower limb vascular surgery

TL;DR

This study shows that the severity of surgical-site infections after lower limb vascular surgery significantly increases both financial and environmental costs.

Contribution

The study introduces a severity-based classification of surgical-site infections to quantify their environmental and financial impacts.

Findings

Environmental emissions increase exponentially with infection severity, with severe cases producing over 2,600 kgCO2e per patient.

Financial costs rise dramatically with infection severity, with severe cases costing up to €37,035 per episode.

The cost per kgCO2e produced by surgical-site infections is approximately €15.58.

Abstract

There is sparse evidence of the relationship between environmental and financial costs of surgical-site infection. Identifying areas of high-cost burden would enable key targets for clinical interventions to aid in achieving the UK national net zero healthcare system strategies. The aim of this study was to evaluate the environmental and financial costs of surgical-site infection, subclassified by severity of infection.

This prospective observational study evaluated patients with and without surgical-site infection after a variety of lower limb vascular surgery using National Health Service and Personal and Social Services perspectives. The severity of surgical-site infection was defined using both Centers for Disease Control and Prevention and management-based criteria where patients with mild surgical-site infection required oral antibiotics, patients with moderate surgical-site infection required intravenous antibiotics, and patients with severe surgical-site infection required further surgical interventions.

A total of 99 patients were included, with 22 patients (22.2%) diagnosed with surgical-site infection. The mean(s.d.) environmental cost without surgical-site infection was 10.3(24.3) kgCO2e (95% c.i. 4.8 to 15.9) per patient. Emissions increased with surgical-site infection severity, with mild producing 94.6(53.9) kgCO2e (95% c.i. 63.5 to 125.8, 918% increase), moderate producing 648(407.6) kgCO2e (95% c.i. −0.1 to 1296.6, 6291% increase) and severe producing 2651.4(2217.1) kgCO2e (95% c.i. −966.5 to 6347.2, 25 742% increase) per patient. The mean(s.d.) financial cost without surgical-site infection was €73.26(€160.27) (95% c.i. 36.91 to 109.72) that increased with severity, with mild costing €392.25(225.69) (95% c.i. 262.16 to 523.00, 536% increase), moderate costing €9754.46(5059.77) (95% c.i. 1704.65 to 17 820.68, 13 317% increase), and severe costing €37 035.60(32 910.84) (95% c.i. −15 376.07 to 89 447.52, 50 521% increase) per episode of infection (£1 = €1.20 (conversion date 25 October 2024)).

Environmental and financial costs are strongly correlated with surgical-site infection severity and display an exponential increase as severity increases. Overall, surgical-site infection incurs a cost of €15.58 for every kgCO2e produced. Environmental discounting should be explored and incorporated into sustainability assessments for robust accounting methodology. Surgical-site infection should be evaluated for severity rather than as a binary outcome for comprehensive assessment.

Surgical-site infection is strongly correlated with both rising financial and environmental costs. Reporting of the severity of infection is imperative for accurate interpretation of intervention effect sizes and health technology assessment.

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