Costs and health burden of surgical site infections and anastomotic leakage in major abdominal surgery
In brief
Surgical-site infections add nearly 30,000 euros and cost patients 13 healthy days
Among 1,119 patients undergoing major abdominal surgery, those with a surgical-site infection had average costs about 29,600 euros higher and lost 12.8 days in perfect health over the first 90 days than patients without infection. Costs were highest with anastomotic leakage, but this secondary analysis does not show whether preventing infections would deliver the same savings.
- Journal
- BJS open (Q1)
- Published
- 4 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Nathan Bontekoning, Hannah Groenen, Stijn W de Jonge, Markus W Hollmann, Marja A Boermeester, Marcel G W Dijkgraaf, et al.
- PMID
- 42808217
- DOI
- 10.1093/bjsopen/zrag111
Why clinicians should know about it
- Picked for Gastrointestinal and Colorectal Surgery (top studies of the week, 4 October 2026): Costs and QoL impact of SSI and anastomotic leak
- Picked for Anatomy (top studies of the week, 4 October 2026): High-quality evidence in a top journal
Abstract
BACKGROUND: Surgical site infection (SSI) is a common postoperative complication. SSI, including anastomotic leakage (AL), is a burden for patients and leads to increased costs, although insights as to the true costs from prospective data are limited. This study aimed to provide an overview of the impact of SSI and AL specifically on total societal costs and the quality of life (QoL) of patients. METHOD: This is a secondary analysis from the EPO2CH trial conducted between 2016 and 2020, which randomized patients scheduled for elective abdominal surgery with incisions > 5 cm to either standard care or standard care plus a bundle aiming to reduce SSI. Prospectively collected clinical data from the EPO2CH trial were used to ascertain the occurrence of SSI (superficial/deep/organ space and AL). The costs and QoL of patients with versus without SSI within 90 days after surgery were evaluated. The primary outcomes were costs (€) and (loss of) health utility, measured as quality-adjusted life-years (QALYs). QoL data were collected using patient questionnaires (EQ-5D™-3L). Unit costs were based on national guidelines for health economic evaluations and locally available unit costs of care. RESULTS: Overall, 1119 of 1777 patients were analysed. Costs in the SSI and non-SSI groups were €53 562 (bias-corrected and accelerated (BCa) 95% confidence interval (c.i.) 45 356 to 68 600]) and €23 969 (BCa 95% c.i. 22 961 to 25 075), respectively, with a mean difference of €29 592 (BCa 95% c.i. 21 206 to 45 674). The greatest mean difference was observed between patients with AL and patients without SSI (€56 401; BCa 95% c.i. 39 487 to 90 892). The maximum attainable mean QALY score over 3 months was 0.25. The mean(standard deviation) QALY score in SSI and non-SSI patients was 0.171(0.050) and 0.205(0.037), respectively, with a mean difference of -0.035 (BCa 95% c.i. -0.042 to -0.029). This corresponds to a loss of 12.78 days in perfect health over the 3-month period. CONCLUSION: Patients with SSI, regardless of its type, had substantially higher healthcare costs and lower QoL after major abdominal surgery than patients without SSI.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.