Clinical and Financial Outcomes Due to Methicillin Resistant Staphylococcus aureus Surgical Site Infection: A Multi-Center Matched Outcomes Study
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{"title"=>"Clinical and financial outcomes due to methicillin resistant staphylococcus aureus surgical site infection: A multi-center matched outcomes study", "type"=>"journal", "authors"=>[{"first_name"=>"Deverick J.", "last_name"=>"Anderson", "scopus_author_id"=>"7410018364"}, {"first_name"=>"Keith S.", "last_name"=>"Kaye", "scopus_author_id"=>"7004675656"}, {"first_name"=>"Luke F.", "last_name"=>"Chen", "scopus_author_id"=>"35306599000"}, {"first_name"=>"Kenneth E.", "last_name"=>"Schmader", "scopus_author_id"=>"7006273135"}, {"first_name"=>"Yong", "last_name"=>"Choi", "scopus_author_id"=>"35408861300"}, {"first_name"=>"Richard", "last_name"=>"Sloane", "scopus_author_id"=>"7007071477"}, {"first_name"=>"Daniel J.", "last_name"=>"Sexton", "scopus_author_id"=>"7103372855"}], "year"=>2009, "source"=>"PLoS ONE", "identifiers"=>{"pui"=>"359087690", "sgr"=>"77749251355", "issn"=>"19326203", "pmid"=>"20016850", "scopus"=>"2-s2.0-77749251355", "doi"=>"10.1371/journal.pone.0008305", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)"}, "id"=>"6c769295-c4dc-36d9-993e-2a534d42c96c", "abstract"=>"BACKGROUND: The clinical and financial outcomes of SSIs directly attributable to MRSA and methicillin-resistance are largely uncharacterized. Previously published data have provided conflicting conclusions. METHODOLOGY: We conducted a multi-center matched outcomes study of 659 surgical patients. Patients with SSI due to MRSA were compared with two groups: matched uninfected control patients and patients with SSI due to MSSA. Four outcomes were analyzed for the 90-day period following diagnosis of the SSI: mortality, readmission, duration of hospitalization, and hospital charges. Attributable outcomes were determined by logistic and linear regression. PRINCIPAL FINDINGS: In total, 150 patients with SSI due to MRSA were compared to 231 uninfected controls and 128 patients with SSI due to MSSA. SSI due to MRSA was independently predictive of readmission within 90 days (OR = 35.0, 95% CI 17.3-70.7), death within 90 days (OR = 7.27, 95% CI 2.83-18.7), and led to 23 days (95% CI 19.7-26.3) of additional hospitalization and $61,681 (95% 23,352-100,011) of additional charges compared with uninfected controls. Methicillin-resistance was not independently associated with increased mortality (OR = 1.72, 95% CI 0.70-4.20) nor likelihood of readmission (OR = 0.43, 95% CI 0.21-0.89) but was associated with 5.5 days (95% CI 1.97-9.11) of additional hospitalization and $24,113 (95% 4,521-43,704) of additional charges. CONCLUSIONS/SIGNIFICANCE: The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.", "link"=>"http://www.mendeley.com/research/clinical-financial-outcomes-due-methicillin-resistant-staphylococcus-aureus-surgical-site-infection", "reader_count"=>61, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>1, "Student > Doctoral Student"=>8, "Researcher"=>12, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>3, "Student > Master"=>10, "Other"=>11, "Student > Bachelor"=>3, "Lecturer > Senior Lecturer"=>1, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>1, "Student > Doctoral Student"=>8, "Researcher"=>12, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>3, "Student > Master"=>10, "Other"=>11, "Student > Bachelor"=>3, "Lecturer > Senior Lecturer"=>1, "Professor"=>1}, "reader_count_by_subject_area"=>{"Engineering"=>3, "Unspecified"=>2, "Nursing and Health Professions"=>1, "Mathematics"=>1, "Medicine and Dentistry"=>28, "Agricultural and Biological Sciences"=>10, "Pharmacology, Toxicology and Pharmaceutical Science"=>4, "Business, Management and Accounting"=>1, "Sports and Recreations"=>1, "Chemistry"=>5, "Social Sciences"=>3, "Computer Science"=>1, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>28}, "Social Sciences"=>{"Social Sciences"=>3}, "Sports and Recreations"=>{"Sports and Recreations"=>1}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>2}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>4}, "Engineering"=>{"Engineering"=>3}, "Chemistry"=>{"Chemistry"=>5}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>10}, "Computer Science"=>{"Computer Science"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}}, "reader_count_by_country"=>{"Sweden"=>1, "United States"=>4, "United Kingdom"=>2}, "group_count"=>2}

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  • {"files"=>["https://ndownloader.figshare.com/files/871790"], "description"=>"a<p>Patients who died during the index admission (n = 23) were excluded from this analysis. Final model controlled for confounding effect of ASA score and contained term for interaction between SSI due to MRSA and Need assistance with ≥3 ADLs. Reference model also included the following variables: sex, history of congestive heart failure, history of cerebrovascular accident, McCabe score = 1, and surgery on same day as admission.</p>b<p>Reference model also included the following variables: admitted from home, Charlson score ≥3, McCabe score = 1, wound class >2, ASA score ≥3, surgery on same day as admission, serum glucose >200 mg/dL, and repeat procedure at same operative site.</p>c<p>Final model controlled for confounding effects of Caucasian race, McCabe score = 1, male sex, coronary artery bypass graft procedures, and surgical duration >75<sup>th</sup> NNIS percentile and contained a term for the interaction of MRSA SSI and need assistance with 3 or more ADLs. Reference model also contained the following variables: BMI≥30, age≥65 years, admission from home, Charlson score ≥3, ASA score ≥3, and repeat procedure at same operative site.</p>d<p>Final model controlled for confounding effects of ASA score ≥3 and contained an interaction term for the interaction between MRSA SSI and need assistance with 3 or more ADLs and an interaction term for the interaction between MRSA SSI and procedure at a tertiary care hospital. Reference model also contained the following variables: need assistance with 3 or more ADLs, receipt of immunosuppressive medications, McCabe score = 1, post-operative serum glucose >200 mg/dL, and orthopedic procedure.</p>", "links"=>[], "tags"=>["predictors", "post-operative", "adverse", "150", "patients", "methicillin-resistant", "surgical", "infections", "compared", "231", "uninfected", "controls", "ssi", "mrsa", "outcomes"], "article_id"=>542225, "categories"=>["Medicine", "Virology"], "users"=>["Deverick J. Anderson", "Keith S. Kaye", "Luke F. Chen", "Kenneth E. Schmader", "Yong Choi", "Richard Sloane", "Daniel J. Sexton"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0008305.t003", "stats"=>{"downloads"=>1, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Independent_Predictors_of_Post_Operative_Adverse_Outcomes_Analysis_of_150_patients_with_methicillin_resistant_Staphylococcus_aureus_MRSA_surgical_site_infections_SSI_compared_with_231_uninfected_controls_to_determine_the_independent_effect_of_SSI_due_to_/542225", "title"=>"Independent Predictors of Post-Operative Adverse Outcomes: Analysis of 150 patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) surgical site infections (SSI) compared with 231 uninfected controls to determine the independent effect of SSI due to MRSA on outcomes of surgical patients.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 03:28:41"}
  • {"files"=>["https://ndownloader.figshare.com/files/871573"], "description"=>"a<p>Charges were normalized to year 2003 by adjusting for inflation at a rate of 0.03% per year.</p>b<p>Adjusted for surgical duration >75<sup>th</sup> NNIS percentile, ASA score ≥3, procedure at tertiary care hospital, Charlson score ≥3, and surgery on same day as admission.</p>c<p>Adjusted for surgical duration >75<sup>th</sup> NNIS percentile, ASA score ≥3, procedure at tertiary care hospital, Charlson score ≥3, surgery on same day as admission, and coronary artery bypass graft surgery.</p>", "links"=>[], "tags"=>["charges", "90", "days", "attributable", "surgical", "methicillin", "resistant", "ssi", "mrsa", "compared"], "article_id"=>542018, "categories"=>["Medicine", "Virology"], "users"=>["Deverick J. Anderson", "Keith S. Kaye", "Luke F. Chen", "Kenneth E. Schmader", "Yong Choi", "Richard Sloane", "Daniel J. Sexton"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0008305.t006", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Length_of_stay_and_hospital_charges_a_within_90_days_of_surgery_attributable_to_surgical_site_infection_SSI_due_to_methicillin_resistant_Staphylococcus_aureus_MRSA_SSI_due_to_MRSA_compared_to_SSI_due_to_MSSA_/542018", "title"=>"Length of stay and hospital charges <sup>a</sup> within 90 days of surgery attributable to surgical site infection (SSI) due to methicillin resistant <i>Staphylococcus aureus</i> (MRSA): SSI due to MRSA compared to SSI due to MSSA.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 03:27:38"}
  • {"files"=>["https://ndownloader.figshare.com/files/871677"], "description"=>"a<p>Patients who died during the index admission (n = 23) were excluded from this analysis. Final model controlled for the confounding effect of Medicaid insurance. Reference model also included the following variables: Charlson score ≥3, wound class >2, ASA score ≥3, surgery on same day as admission, post-operative glucose >200 mg/dl, and receipt of effective antimicrobial therapy after infection.</p>b<p>Final model controlled for the confounding effects of age, ASA score, coronary artery bypass graft procedure, and admission to the ICU prior to infection. Reference model also included the following variables: Medicaid insurance, Charlson score ≥3, post-operative glucose >200 mg/dl, and receipt of effective antimicrobial therapy after infection.</p>c<p>Final model controlled for the confounding effects of surgical duration >75<sup>th</sup> NNIS percentile. Reference model also contained the following variables: BMI ≥30, age ≥65 years, admission from home, McCabe score = 1, post-operative glucose >200 mg/dl, coronary artery bypass grafting, orthopedic procedure, and appropriate administration of peri-operative antimicrobial prophylaxis.</p>d<p>Final model controlled for confounding effects of Charlson score ≥3 and coronary artery bypass graft surgery. Reference model also contained the following variables: age ≥65 years, admission from home, lack of independence with ambulation, McCabe score = 1, post-operative serum glucose >200 mg/dL, and orthopedic procedure.</p>", "links"=>[], "tags"=>["predictors", "post-operative", "adverse", "150", "patients", "methicillin-resistant", "surgical", "infections", "compared", "128", "methicillin-susceptible", "ssi", "methicillin-resistance"], "article_id"=>542115, "categories"=>["Medicine", "Virology"], "users"=>["Deverick J. Anderson", "Keith S. Kaye", "Luke F. Chen", "Kenneth E. Schmader", "Yong Choi", "Richard Sloane", "Daniel J. Sexton"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0008305.t005", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Independent_Predictors_of_Post_Operative_Adverse_Outcomes_Analysis_of_150_patients_with_methicillin_resistant_Staphylococcus_aureus_MRSA_surgical_site_infections_SSI_compared_with_128_patients_with_methicillin_susceptible_S_aureus_MSSA_SSI_to_determine_i/542115", "title"=>"Independent Predictors of Post-Operative Adverse Outcomes: Analysis of 150 patients with methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) surgical site infections (SSI) compared with 128 patients with methicillin-susceptible <i>S. aureus</i> (MSSA) SSI to determine independent effect of methicillin-resistance on patients with <i>S. aureus</i> SSI.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 03:28:09"}
  • {"files"=>["https://ndownloader.figshare.com/files/871630"], "description"=>"a<p>Charges were normalized to year 2003 by adjusting for inflation at a rate of 0.03% per year.</p>b<p>Adjusted for procedure at tertiary care hospital, need assistance with ≥3 ADLs, post-operative serum glucose >200 mg/dL, orthopedic procedure, caucasian race, McCabe score = 1, male sex, coronary artery bypass graft procedures, surgical duration >75<sup>th</sup> NNIS percentile, and contained a term for the interaction of MRSA SSI and need assistance with 3 or more ADLs.</p>c<p>Adjusted for procedure at tertiary care hospital, coronary artery bypass graft procedure, surgical duration >75<sup>th</sup> NNIS percentile, procedure on same day as admission, ASA score ≥3, the interaction between MRSA SSI and need assistance with 3 or more ADLs and the interaction between MRSA SSI and procedure at a tertiary care hospital.</p>", "links"=>[], "tags"=>["charges", "90", "days", "attributable", "surgical", "methicillin", "resistant", "ssi", "mrsa", "compared", "uninfected"], "article_id"=>542070, "categories"=>["Medicine", "Virology"], "users"=>["Deverick J. Anderson", "Keith S. Kaye", "Luke F. Chen", "Kenneth E. Schmader", "Yong Choi", "Richard Sloane", "Daniel J. Sexton"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0008305.t004", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Length_of_stay_and_hospital_charges_a_within_90_days_of_surgery_attributable_to_surgical_site_infection_SSI_due_to_methicillin_resistant_Staphylococcus_aureus_MRSA_SSI_due_to_MRSA_compared_to_uninfected_controls_/542070", "title"=>"Length of stay and hospital charges <sup>a</sup> within 90 days of surgery attributable to surgical site infection (SSI) due to methicillin resistant <i>Staphylococcus aureus</i> (MRSA): SSI due to MRSA compared to uninfected controls.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 03:27:53"}
  • {"files"=>["https://ndownloader.figshare.com/files/871494"], "description"=>"<p>Kaplan-Meier Survival Analysis of mortality among patients with surgical site infection (SSI) due to methicillin resistant <i>Staphylcoccus aureus</i>, SSI due to methicillin-susceptible <i>S. aureus</i>, and uninfected controls.</p>", "links"=>[], "tags"=>["cases"], "article_id"=>541944, "categories"=>["Medicine", "Virology"], "users"=>["Deverick J. Anderson", "Keith S. Kaye", "Luke F. Chen", "Kenneth E. Schmader", "Yong Choi", "Richard Sloane", "Daniel J. Sexton"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0008305.g001", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Survival_analysis_of_cases_and_controls_/541944", "title"=>"Survival analysis of cases and controls.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-21 03:27:11"}
  • {"files"=>["https://ndownloader.figshare.com/files/871738"], "description"=>"a<p>P values calculated using Student t test or Wilcoxon rank sum test for continuous variables. P-values, odds ratios, and 95% confidence intervals for categorical variables were calculated using the Cochran-Mantel-Haenszel test (MRSA SSI v. matched-uninfected controls) and the Fisher exact test or chi-square (MRSA SSI v MSSA SSI). All percentages were calculated using denominators that excluded missing data.</p>b<p>Denominator includes patients who survived their index admissions.</p>c<p>Financial data were available for 144 cases (96%), 202 (87%) uninfected controls, and 127 (99%) MSSA SSI controls.</p>", "links"=>[], "tags"=>["150", "patients", "methicillin-resistant", "surgical", "infections", "compared", "231", "uninfected", "controls", "128", "methicillin-susceptible"], "article_id"=>542178, "categories"=>["Medicine", "Virology"], "users"=>["Deverick J. Anderson", "Keith S. Kaye", "Luke F. Chen", "Kenneth E. Schmader", "Yong Choi", "Richard Sloane", "Daniel J. Sexton"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0008305.t002", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Unadjusted_clinical_and_financial_outcomes_a_of_150_patients_with_methicillin_resistant_Staphylococcus_aureus_surgical_site_infections_SSI_compared_with_231_uninfected_controls_and_128_patients_with_methicillin_susceptible_S_aureus_SSI_/542178", "title"=>"Unadjusted clinical and financial outcomes<sup>a</sup> of 150 patients with methicillin-resistant <i>Staphylococcus aureus</i> surgical site infections (SSI) compared with 231 uninfected controls and 128 patients with methicillin-susceptible <i>S. aureus</i> SSI.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 03:28:25"}
  • {"files"=>["https://ndownloader.figshare.com/files/871846"], "description"=>"<p>A - All percentages were calculated using denominators that excluded missing data. Data were missing for the following variables: McCabe score (4 MRSA SSI, 5 uninfected controls, 10 MSSA SSI), BMI (12 MRSA SSI, 12 uninfected controls, 11 MSSA SSI), use of immunosuppressive medications (8 MRSA SSI, 6 uninfected controls, 10 MSSA SSI), repeat procedure (3 MRSA SSI, 8 uninfected controls, 3 MSSA SSI), operative procedure >75<sup>th</sup> percentile (65 MRSA SSI, 66 uninfected controls, 64 MSSA SSI), ASA score (1 MRSA SSI, 7 uninfected controls, 4 MSSA SSI), serum glucose (37 MRSA SSI, 67 uninfected controls, 39 MSSA SSI), antimicrobial prophylaxis (7 MRSA SSI, 5 uninfected controls, 3 MSSA SSI), same day procedure (1 uninfected control).</p><p>B - p<0.001 compared to patients with SSI due to MRSA.</p><p>C - p<0.05 compared to patients with SSI due to MRSA.</p>", "links"=>[], "tags"=>["characteristics", "150", "patients", "methicillin-resistant", "surgical", "infections", "compared", "231", "uninfected", "controls", "128", "methicillin-susceptible"], "article_id"=>542286, "categories"=>["Medicine", "Virology"], "users"=>["Deverick J. Anderson", "Keith S. Kaye", "Luke F. Chen", "Kenneth E. Schmader", "Yong Choi", "Richard Sloane", "Daniel J. Sexton"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0008305.t001", "stats"=>{"downloads"=>1, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Key_characteristics_of_150_patients_with_methicillin_resistant_Staphylococcus_aureus_surgical_site_infections_SSI_compared_with_231_uninfected_controls_and_128_patients_with_methicillin_susceptible_S_aureus_SSI_a_/542286", "title"=>"Key characteristics of 150 patients with methicillin-resistant <i>Staphylococcus aureus</i> surgical site infections (SSI) compared with 231 uninfected controls and 128 patients with methicillin-susceptible <i>S. aureus</i> SSI.<sup>a</sup>", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-21 03:28:59"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"12", "full-text"=>"15", "pdf"=>"5", "abstract"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2017", "month"=>"3"}
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  • {"unique-ip"=>"12", "full-text"=>"16", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"10"}
  • {"unique-ip"=>"7", "full-text"=>"7", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"11"}
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  • {"unique-ip"=>"10", "full-text"=>"12", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"2"}
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  • {"unique-ip"=>"12", "full-text"=>"9", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
  • {"unique-ip"=>"11", "full-text"=>"9", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"5"}
  • {"unique-ip"=>"12", "full-text"=>"9", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"8"}
  • {"unique-ip"=>"21", "full-text"=>"22", "pdf"=>"9", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"9"}
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Relative Metric

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