The impact of surgical-site infection on health utility values: a meta-analysis

Abstract

Background: SSI are recognised as negatively affecting patient quality of life. Currently, no meta-analysis of SSI utility values is available in the literature to inform estimates of this burden and investment decisions in prevention. Method: A systematic search of PubMed, Medline, CINAHL and the NHS Economic Evaluation Database was performed in April 2022 as per PROSPERO registration CRD 42021262633. Studies were included where quality of life data was gathered from adults undergoing surgery whereby quality of life data was presented as those with infection and those without at similar time points. Two researchers performed data extraction and quality appraisal independently, with a third as arbiter. Utility values were converted to EQ-5D. Meta-analyses were conducted using a random effects model across all relevant studies with subgroup analyses on SSI type and timing since surgery. Results: 15 studies met the inclusion criteria with 2817 patients; six studies across seven time points were used for meta-analysis. The pooled mean difference in EQ-5D utility in all studies combined was – 0.08 (95% CI -0.11 - -0.05, I2 = 40%, prediction interval -0.16 to -0.01.). The mean difference in EQ-5D utility associated with Deep SSI was -0.10 (95%CI -0.14 - -0.06, I2 = 0.00%) and the mean difference in EQ-5D persisted over time. Conclusion: The first synthesised estimate of SSI burden over the short and long term is provided. EQ-5D utility estimates for a range of SSI are essential for infection prevention planning and future economic modelling.