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

Lathan, R; Daysley, H; Ravindhran, B; Lim, A; Cutteridge, J; Sidapra, M; Long, J; Hitchman, L; Beltran-Alvarez, P; Carradice, D; Smith, G; Chetter, I

Abstract

Background
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.

Methods
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.

Results
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)).

Conclusion
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.

Citation

Lathan, R., Daysley, H., Ravindhran, B., Lim, A., Cutteridge, J., Sidapra, M., Long, J., Hitchman, L., Beltran-Alvarez, P., Carradice, D., Smith, G., & Chetter, I. (2025). Environmental and financial cost of surgical-site infection by severity after lower limb vascular surgery. BJS Open, 9(3), Article zraf015. https://doi.org/10.1093/bjsopen/zraf015

• Journal Article Type: Article
• Acceptance Date: Jan 9, 2025
• Online Publication Date: May 7, 2025
• Publication Date: 2025-06
• Deposit Date: Oct 25, 2024
• Publicly Available Date: May 13, 2025
• Print ISSN: 2474-9842
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 3
• Article Number: zraf015
• DOI: https://doi.org/10.1093/bjsopen/zraf015
• Public URL: https://hull-repository.worktribe.com/output/4871284