Epidemiology, patient-related risk factors, and costs associated with soft tissue hand infections: A nationwide database study
John T Heineman, MD, MPH, Benjamin F Sandberg, MD and Brent R DeGeorge, MD, PhD, University of Virginia, Charlottesville, VA
Background: Soft tissue hand infections are some of the most common diagnoses treated by hand surgeons. Despite the frequency of these infections the epidemiology, patient-related risk factors, and costs have not been described in a large nationally representative patient sample.
Methods: The PearlDiver Database was queried for International Classification of Diseases, Ninth and Tenth Edition (ICD-9 and ICD-10) codes associated with soft tissue infections of the hand. Patients were further stratified by Current Procedure Terminology (CPT) codes for debridement and inpatient admission. Patient demographics, associated medical comorbidities, and cost data were analyzed.
Results: We identified 106,829 patients (5.4%) with a diagnosis of soft tissue infection of the hand. Of these, 4,494 (4.2%) underwent a debridement procedure and 5,767 (5.4%) were admitted. The most common diagnoses associated with debridement were cellulitis and abscess of the hand followed by the fingers. The most common procedures performed were simple followed by complex incision and drainage of abscess.
Linear regression analysis demonstrated association with multiple patient-related risk factors. The male to female ratio of patients undergoing debridement was 1.20. More debridement procedures were performed with increasing age with a peak incidence between 65 and 69 years of age. Debridement was most common in the South region followed by the Midwest, West, and Northeast. Using linear regression analysis, Charlson comorbidity index, chronic hepatitis, chronic kidney disease, diabetes, IV drug abuse, history of MRSA, obesity, rheumatoid arthritis, and current tobacco use demonstrated a statistically significant association with debridement procedures.
The cost of soft tissue hand infections increased with escalation of care from diagnosis to debridement and admission. The amount paid for those patients diagnosed with a soft tissue hand infection totaled $21,371,984 with an average of $200 per patient. The most common diagnoses of cellulitis and abscess of the finger and hand incurred the highest total costs with $3,717,367 and $12,923,739 paid respectively. The amount paid for those patients who underwent a debridement procedure totaled $1,863,023 with an average of $415.56 per patient. The amount paid for those patients admitted to the hospital totaled $5,485,386 and averaged $933.83 per patient.
Conclusions: Soft tissue hand infections represent a significant burden to the health care system. Patient-related risk factors are associated with an increased likelihood of undergoing a debridement or inpatient admission that is correlated with increasing direct costs.
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