Cost Analysis of a Care Bundle for the Prevention of Surgical Site Infections After Craniotomy

An operating room also called surgery center, is the unit of a hospital where surgical procedures are performed.
Researchers conducted a study to determine the monetary effect of a surgical care bundle for the prevention of surgical site infections among patients undergoing craniotomy procedures.

The implementation of a care bundle for the prevention of postoperative surgical site infections among patients undergoing craniotomy (SSI-CRAN) was found to significantly decrease the healthcare costs associated with the procedure, according to results of a study published in Antimicrobial Resistance and Infection Control.

To assess the economic impact of the care bundle, researchers performed a retrospective cost analysis that compared the period prior to the implementation of the care bundle (2013-2015) vs the period after the care bundle was implemented (2016-2017). For both periods, and on a patient-by-patient basis, the researchers calculated the costs associated with craniotomy procedures among patients who developed SSIs vs those who did not. The researchers analyzed the costs associated with the following factors: antibiotic treatment regimen, length of stay in the neurosurgery ward within a 1-year follow up period, re-intervention, and implants for cranial reconstruction.

Among a total of 1017 patients included in the analysis, 595 and 442 underwent craniotomy procedures in the pre-care bundle and care-bundle periods, respectively. Of note, the incidence of SSI-CRAN was significantly decreased in the care bundle period vs the pre-care bundle period (3.5% vs. 15.3%; P <.001).

The mean cost of a craniotomy and a SSI-CRAN was approximately €8000 (95% CI, 7350.6-8710.9) and €24,000 (95% CI, 21,180.6-27,316.4), respectively. Following the implementation of the care bundle, the costs associated with patients who developed SSI-CRAN were decreased compared with the costs associated with those who developed SSI-CRAN in the pre-care bundle period (€714,886 vs €212,029, respectively). Of note, the increased costs observed during the pre-care bundle period were found to be mainly attributable to increases in the length of hospitalization and surgical implants for patients who required cranial reconstruction.

After the care bundle was implemented, the researchers noted that the healthcare system saved a total of €500,844 by preventing SSI-CRAN.

This study was limited by its inclusion of only patients hospitalized at a single center. In addition, cost factors such as total parenteral nutrition, treatment at or readmission to another hospital, laboratory and imaging studies, and diagnostic testing were not included in the analysis.

According to the researchers, “hospitals should incorporate the surveillance of [SSIs] in the area of neurosurgery and should implement strategies such as the [care] bundle described here in order to [decrease] the burden of SSIs, in terms of both patient suffering and healthcare costs.”


Jiménez-Martínez E, Cuervo G, Carratalà J, et al. Economic impact of a care bundle to prevent surgical site infection after craniotomy: a cost-analysis study.

Antimicrob Resist Infect Control. 2021;10(1):146. doi: 10.1186/s13756-021-01016-4.