Direct economic and temporal burdens of nosocomial infections on orthopaedic patients: A nested case‒control study

Orthopaedic inpatients have distinct clinical traits.This study aimed to quantify the burden of nosocomial infections (NIs) on orthopaedic patients from a healthcare system perspective.A nested case-control study (2022)(2023)(2024) at the China National Orthopaedic Medical Center compared orthopaedic inpatients with and without NIs and matched cases and controls 1:3 by age, sex, diagnosis-related group (DRG), medical payments, and preinfection time to evaluate the burden of NIs.A national economic burden analysis was subsequently conducted under various scenarios.Among 120,764 eligible patients, 338 (0.28%) developed NIs.A total of 321 cases were matched with 916 controls.The economic and temporal burdens of NIs are US$2,100 and 5 days per case, respectively.Haematologic NIs had the highest additional cost (US$4,295) and the second longest extended stay (9 days).In terms of initial hospitalisations and readmissions, surgical site infections extended hospital stays by 20 days and increased costs by US$4,881.The top three DRGs with high burdens are ZC11, ZJ15, and IE21 for costs and ZJ15, IE21, and IB19 for duration.In the mixed-region scenario, orthopaedic specialty hospitals nationwide incur US$5.23 million in direct medical costs annually because of NIs.These findings indicate that NIs significantly affect orthopaedic patients both individually and nationally, necessitating focused prevention and control for high-burden DRGs and specific infections.