Costs of surgical site infections in orthopaedic and trauma surgery: a systematic review
Maike Stolz, Julia Schmetsdorf, Ivonne Tomsic, Thomas von Lengerke, Iris F. Chaberny, Christian Krauth
Abstract
BACKGROUND: Surgical site infections (SSIs) are among the most common hospital-acquired infections. They have a particularly significant impact on orthopaedic and trauma surgery due to their severe clinical and economic consequences. AIM: This systematic review aimed to quantify the additional direct costs of SSIs in orthopaedic and trauma surgery, considering only studies that statistically adjusted for other cost-influencing variables. METHODS: PubMed and Web of Science databases were searched for literature published between January 2010 and February 2025. Only original studies were selected. Costs were standardized to 2023 US dollars using inflation and purchasing power adjustments. Study quality was assessed using a 17-item checklist based on established frameworks. RESULTS: Thirty-six studies met the inclusion criteria. SSIs were found to lead to a median relative cost increase of 120% (interquartile range [IQR]: 76%-185%) and a median absolute increase of $24,230. Costs varied according to procedure type, infection depth, follow-up duration and region. Hip and knee replacements incurred the highest long-term costs. Deep SSIs were significantly more expensive than superficial ones. Studies with a high-quality score tended to report higher relative cost increases (129% vs 112%). CONCLUSION: SSIs substantially increase treatment costs in orthopaedic and trauma surgery, particularly for deep infections and joint replacements over longer follow-up periods. The results emphasize the economic benefits of SSI prevention and the importance of robust methodological standards in cost evaluations.