Current Thoracic Surgery 2019 , Vol 4 , Issue 2
Cost analysis and evaluation of risk factors for postoperative pneumonia after thoracic and cardiovascular surgery: a single-center study
Aysegul Inci Sezen1,Celal Bugra Sezen2,Sevgi Sokulmez Yildirim3,Murat Dizbay4,Fatma Ulutan4
1Department of Infections Diseases and Clinical Microbiology, Haseki Research and Education Hospital, Istanbul, Turkey
2Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Research and Education Hospital, Istanbul, Turkey
3Ankara Occupational and Environmental Diseases Hospital, Ankara, Turkey
4Department of Infections Diseases and Clinical Microbiology Faculty of Medicine, Gazi University, Ankara, Turkey
DOI : 10.26663/cts.2019.00011 Viewed : 4797 - Downloaded : 1359 Background: Postoperative pneumonia increases costs associated with inpatient stay, treatment, laboratory testing, and imaging, thereby increasing total healthcare costs. The aim of this study was to determine risk factors in patients who develop pneumonia after thoracic and cardiovascular surgery, evaluate relationships between these risk factors and cost, and conduct a cost analysis of postoperative pneumonia.

Materials and Methods: 111 patients who underwent major thoracic or cardiovascular surgery between June 2009 and March 2014 were evaluated retrospectively. Patients who developed postoperative pneumonia (p = 37) were compared with those who had no postoperative complications (p = 74).

Results: 40 men and 71 women were included in the study. Mean length of hospital stay was 21 days for patients with pneumonia versus 10 days for patients without pneumonia (p < 0.001). Significant risk factors for postoperative pneumonia were Charlson Comorbidity Index > 2, steroid use, high ASA score, presence of nasogastric tube, peripheral/central venous catheterization, postoperative heart failure/acute kidney failure, total parenteral nutrition, late postoperative mobilization, and prolonged ventilation and intubation (p < 0.05). Postoperative pneumonia was associated with significantly higher mortality rate and total cost (p < 0.001 for both). The mean cost of treatment for patients with and without postoperative pneumonia was 8211.7 TL and 3917.5 TL, respectively (p < 0.001). There were statistically significant differences between the two groups in the costs of surgery, radiology, antibiotics, and cultures (p < 0.001 for all). Correlation analysis between risk factors and cost revealed that prolonged intubation, late mobilization, and lack of respiratory rehabilitation exercises were associated with higher costs (p < 0.05).

Conclusions: Postoperative pneumonia significantly increases costs. Identifying and mitigating these factors will reduce both the incidence of infection and the associated costs. Because infection control measures help avoid infection and thereby infection-related costs, it is critically important to support infection control activities and prevent nosocomial infections. Keywords : cost analysis, pneumonia, prognostic factors