Surgical Site Infections and their economic significance in hepatopancreatobiliary surgery: A retrospective incidence, cost, and reimbursement analysis in a German centre of the highest level of care.

Surgical site infections (SSI) in open Hepatopancreatobiliary (HPB) surgery are common complications. They worsen patients' outcomes and prolong hospital stays. Their economic significance in the German diagnosis related groups (DRG) system is mostly unknown. To investigate their economic importance, we evaluated all cases for SSIs as well as clinical and financial parameters undergoing surgery in our centre from 2015 and 2016. Subsequently, we carried out a cost-revenue calculation by assessing our billing data and the cost matrix of the InEK (German Institute for the Payment System in Hospitals). A total of 13.5% of the patients developed a superficial, 9% a deep incisional, and 2.4% of the patients an organ space SSI. Compared with Patients without SSI, Patients with SSI had more comorbidities, were older, and their average length of stay was extended by 19 days (P < .001). The financial loss per SSI-case was €-7035.65 despite increased reimbursement, which resulted in a calculated total loss for the hospital of €-802 064.62 in 2015 and 2016. Surgical site infections are common complications of open HPB surgery, which lead to a significant increase in the cost per case. Further prevention strategies need to be developed. Besides, an adjustment of revenues must be demanded.

Management of Open Abdominal Wounds With Intestinal Fistula Formation Using a Combination of Negative Pressure Wound Therapy With Instillation and Dwell Time and New Generation Fistula Devices: A Case Report.

INTRODUCTION: Open abdominal wounds with intestinal fistula formation are challenging complications in abdominal surgery. Special fistula devices (SFD) used along with negative pressure wound therapy with instillation and dwell time (NPWTi-d), may improve management of these wounds, increasing NPWT dressing durability and helping decrease dressing leakage. CASE REPORT: A 57-year-old, obese (body mass index: 55 kg/m²) female with a long history of Crohn disease and multiple intestinal resections, presented with an incarcerated parastomal hernia, abscess formation, and septic shock. After the hernia was repositioned and the infection controlled, a bovine mesh-augmented hernia repair was performed. Skin rotation flaps for wound closure became necrotic and led to an infected, open abdominal wound measuring about 60 cm x 50 cm with formation of 2 additional small bowel fistulas alongside the ostomy and a massive bacterial and fungal superinfection. After surgical debridement, NPWTi-d with 10 minutes soaking time with isotonic saline solution followed by 2 to 4 hours negative pressure therapy with -125 mm Hg combined with SFDs was initiated; once the infection was controlled approximately 3 weeks after initiation, treatment was switched to traditional NPWT with -125 mm Hg continuous negative pressure and SFDs. Dressings were changed on demand. During the whole treatment period, local infection was brought under control, the wound was clean, and thick granulation tissue formed (even on exposed parts of the mesh). The dressing stability provided a high level of patient comfort. CONCLUSIONS: By providing expedient wound cleaning, decontamination, local infection control, and patient comfort, as well as helping generate granulation tissue even on biological mesh, NPWTi-d used with SFDs represents a viable tool for the management of challenging fistulizing abdominal wounds.