Medico

JKSS

J Korean Surg Soc 2011;81:295-307
http://dx.doi.org/10.4174/jkss.2011.81.5.295

Journal of the Korean Surgical Society

pISSN 2233-7903ㆍeISSN 2093-0488

ORIGINAL ARTICLE

The epidemiology and cost of surgical site infections in
Korea: a systematic review
Kil Yeon Lee, Kristina Coleman1, Dan Paech1, Sarah Norris1, Jonathan T Tan1
Department of Surgery, Kyung Hee UniversitySchool of Medicine, Seoul, Korea, 1Health Technology Analysts Pty Ltd, Sydney,
Australia

Purpose: To conduct a systematic literature review of the epidemiological and economic burden of surgical site infection
(SSI) in Korea. Methods: A search of the EMBASE, Medline and KoreaMed databases for English and Korean language publications was conducted. Searches for epidemiological and economic studieswere conducted separately and limited to 1995
to 2010 to ensure the pertinence of the data. Results: Twenty-six studies were included. The overall incidence of SSI in Korea
was 2.0 to 9.7%. The National Nosocomial Infections Surveillance risk index was positively correlated with the risk of developing an SSI. Specific risk factors for SSI, identified through multivariate analyses included;diabetes, antibiotic prophylaxis
and wound classification. SSIs were associated with increased hospitalisation cost, with each episode of SSI estimated to cost
about an additional ￦2,000,000. A substantial portion of the increased cost was attributed to hospital room costs and the
need for additional medication. Studies also found that post-operative stays for patients with SSIs were 5 to 20 dayslonger,
while two studies reported that following cardiac surgery, patients with SSIs spent an additional 5 to 11 days in the intensive
care unit, compared to patients without SSIs. Conclusion: Data from the included studies demonstrate that SSI represents a
significant clinical and economic burden in Korea. Consequently, the identification of high-risk patient populations and the
developmentof strategies aimed at reducing SSI may lead to cost-savings for the healthcare system.
Key Words: Surgical site infection, Epidemiology, Cost

pertaining to the clinical and economic burden of SSI in

INTRODUCTION

Korea. This systematic review will follow the general forA surgical site infection (SSI) is a type of hospital-

mat of the publication by Leaper et al. [1] which describesacquired infection that arises following surgery and is spe-

the epidemiological and economic burden of SSI in

cifically related to the surgical site. Patients who develop

Europe.

an SSI are more likely to have an extended hospital stay,
which results in additional healthcare costs. Indirect costs,
such as productivity, further add to the burden of SSI.
The aim of this review is tosummarise recent evidence
Received April 22, 2011, Revised July 30, 2011, Accepted August 9, 2011
Correspondence to: Kil Yeon Lee
Department of Surgery, Kyung Hee University School of Medicine, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea
Tel: ＋82-2-958-8261, Fax: ＋82-2-966-9366, E-mail: isaac34@korea.com
cc Journal of the Korean Surgical Society is an Open Access Journal. All articlesare distributed under the terms of the Creative Commons
Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original work is properly cited.

Copyright © 2011, the Korean Surgical Society

Kil Yeon Lee, et al.

2. Describes the effect of an interventionto reduce SSI.

METHODS

3. Not conducted in Korea.
4. Not conducted in a hospital setting.

Literature search
In order to identify relevant epidemiological and eco-

5. Includes ＜90 patients/procedures.

nomic data for this review, a systematic search of the liter-

Following application of the exclusion criteria to the ti-

ature was undertaken. A search of Embase (which in-...