CLINICAL RESEARCH: The elimination of surgical site infections may leave trusts worse off financially for their work on certain specialisms, a study conducted by Plymouth Hospitals Trust suggests.

A team monitored more than 14,000 major surgical procedures across 19 surgical categories undertaken at the trust between April 2010 and March 2012.

It used Plymouth’s patient level and costing information system to calculate the additional cost to the trust when patients contracted an infection through factors such as extended length of stay, additional theatre time, the cost of drugs and staffing, and considered payment under the tariff.

About 2 per cent of patients contracted an infection and their length of stay was on average 10 days longer. The study team also calculated the opportunity cost of additional work the trust would have been able to carry out if these longer stays or readmissions were not required.

Despite surgical site infections costing the trust an additional £2.4m, even when the opportunity cost was taken into account the trust would only have been £700,000 better off if all infections had been eliminated.

In seven specialisms − including hip replacements, abdominal hysterectomies and spinal procedures − the trust would have been financially worse off had it eliminated all surgical site infections.

In what the researchers describe as a “paradox”, the trust made a loss on patients who underwent cholecystectomy and small bowel surgery but did not contract an infection, but profits of £882 and £13,472 respectively on those that did.

Lead researcher Peter Jenks, a consultant microbiologist at the trust, said: “Despite the fact that we accounted for everything, including financial penalties for readmissions, we were still receiving more income [for patients with surgical site infections].”

The research, published in the Journal of Hospital Infection, was carried out by a team from the trust’s microbiology, infection prevention and control, and finance departments. It is the first in the UK to link the cost of patient episodes with surgical outcomes.

The study also found the trust made an aggregate loss on all of the categories considered when patients did not contract an infection.

Dr Jenks said the payment system should change from fines for infection incidence to using incentives to reduce infections.