{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:05:51Z","timestamp":1790672751701,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Netherlands Organization for Health Research and Innovation"},{"DOI":"10.13039\/501100009248","name":"Innovatiefonds Zorgverzekeraars","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009248","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009933","name":"Ethicon Inc.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009933","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical site infection (SSI) is a common postoperative complication. SSI, including anastomotic leakage (AL), is a burden for patients and leads to increased costs, although insights as to the true costs from prospective data are limited. This study aimed to provide an overview of the impact of SSI and AL specifically on total societal costs and the quality of life (QoL) of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This is a secondary analysis from the EPO2CH trial conducted between 2016 and 2020, which randomized patients scheduled for elective abdominal surgery with incisions &amp;gt; 5 cm to either standard care or standard care plus a bundle aiming to reduce SSI. Prospectively collected clinical data from the EPO2CH trial were used to ascertain the occurrence of SSI (superficial\/deep\/organ space and AL). The costs and QoL of patients with versus without SSI within 90 days after surgery were evaluated. The primary outcomes were costs (\u20ac) and (loss of) health utility, measured as quality-adjusted life-years (QALYs). QoL data were collected using patient questionnaires (EQ-5D\u2122-3L). Unit costs were based on national guidelines for health economic evaluations and locally available unit costs of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 1119 of 1777 patients were analysed. Costs in the SSI and non-SSI groups were \u20ac53 562 (bias-corrected and accelerated (BCa) 95% confidence interval (c.i.) 45 356 to 68 600]) and \u20ac23 969 (BCa 95% c.i. 22 961 to 25 075), respectively, with a mean difference of \u20ac29 592 (BCa 95% c.i. 21 206 to 45 674). The greatest mean difference was observed between patients with AL and patients without SSI (\u20ac56 401; BCa 95% c.i. 39 487 to 90 892). The maximum attainable mean QALY score over 3 months was 0.25. The mean(standard deviation) QALY score in SSI and non-SSI patients was 0.171(0.050) and 0.205(0.037), respectively, with a mean difference of \u22120.035 (BCa 95% c.i. \u22120.042 to \u22120.029). This corresponds to a loss of 12.78 days in perfect health over the 3-month period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with SSI, regardless of its type, had substantially higher healthcare costs and lower QoL after major abdominal surgery than patients without SSI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag111","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:59:50Z","timestamp":1783598390000},"source":"Crossref","is-referenced-by-count":0,"title":["Costs and health burden of surgical site infections and anastomotic leakage in major abdominal surgery"],"prefix":"10.1093","volume":"10","author":[{"given":"Nathan","family":"Bontekoning","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Groenen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0693-3111","authenticated-orcid":false,"given":"Stijn W","family":"de Jonge","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus W","family":"Hollmann","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3890-8105","authenticated-orcid":false,"given":"Marja A","family":"Boermeester","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel G W","family":"Dijkgraaf","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Methodology, Amsterdam Public Health , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0573-5703","authenticated-orcid":false,"given":"Niels","family":"Wolfhagen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC, University of Amsterdam , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam Gastroenterology Endocrinology & Metabolism , Amsterdam ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the EPO2CH Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Q J J","family":"Boldingh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W J","family":"Bom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J C G","family":"Scheijmans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L R C W","family":"van Lonkhuijzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Demirkiran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O E","family":"van Geffen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E B","family":"Kluyver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E R","family":"Hendriks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J-P","family":"Hering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D J A","family":"Sonneveld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J A B","family":"van der Hoeven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B M F","family":"van der Leeuw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L M","family":"Posthuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"2026092904322996100_zrag111-B1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.ajic.2008.12.010","article-title":"Surgical site infection: incidence and impact on hospital utilization and treatment costs","volume":"37","author":"de Lissovoy","year":"2009","journal-title":"Am J Infect Control"},{"key":"2026092904322996100_zrag111-B2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1001\/jamasurg.2019.4539","article-title":"Association of postoperative infection with risk of long-term infection and mortality","volume":"155","author":"O'Brien","year":"2020","journal-title":"JAMA Surg"},{"key":"2026092904322996100_zrag111-B3","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1016\/S1473-3099(18)30101-4","article-title":"Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study","volume":"18","author":"GlobalSurg Collaborative","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2026092904322996100_zrag111-B4","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.ejso.2019.10.038","article-title":"The impact of anastomotic leakage on recurrence and long-term survival in patients with colonic cancer: a systematic review and meta-analysis","volume":"46","author":"Bashir Mohamed","year":"2020","journal-title":"Eur J Surg Oncol"},{"key":"2026092904322996100_zrag111-B5","doi-asserted-by":"crossref","first-page":"102105","DOI":"10.1016\/j.eclinm.2023.102105","article-title":"Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis","volume":"62","author":"Groenen","year":"2023","journal-title":"EClinicalMedicine"},{"key":"2026092904322996100_zrag111-B6","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1001\/jamasurg.2024.0775","article-title":"Incisional wound irrigation for the prevention of surgical site infection: a systematic review and network meta-analysis","volume":"159","author":"Groenen","year":"2024","journal-title":"JAMA Surg"},{"key":"2026092904322996100_zrag111-B7","doi-asserted-by":"crossref","first-page":"e762","DOI":"10.1016\/S2666-5247(22)00187-2","article-title":"Efficacy of different preoperative skin antiseptics on the incidence of surgical site infections: a systematic review, GRADE assessment, and network meta-analysis","volume":"3","author":"Jalalzadeh","year":"2022","journal-title":"Lancet Microbe"},{"key":"2026092904322996100_zrag111-B8","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1007\/s00423-021-02346-y","article-title":"The impact of surgical site infection\u2014a cost analysis","volume":"407","author":"Strobel","year":"2022","journal-title":"Langenbecks Arch Surg"},{"key":"2026092904322996100_zrag111-B9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jhin.2013.09.012","article-title":"Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital","volume":"86","author":"Jenks","year":"2014","journal-title":"J Hosp Infect"},{"key":"2026092904322996100_zrag111-B10","doi-asserted-by":"crossref","first-page":"e0275970","DOI":"10.1371\/journal.pone.0275970","article-title":"Clinical and economic burden of surgical site infections in inpatient care in Germany: a retrospective, cross-sectional analysis from 79 hospitals","volume":"17","author":"Eckmann","year":"2022","journal-title":"PLoS One"},{"key":"2026092904322996100_zrag111-B11","doi-asserted-by":"crossref","first-page":"e038196","DOI":"10.1136\/bmjopen-2020-038196","article-title":"Enhanced PeriOperative Care and Health protection programme for the prevention of surgical site infections after elective abdominal surgery (EPOCH): study protocol of a randomised controlled, multicentre, superiority trial","volume":"10","author":"de Jonge","year":"2020","journal-title":"BMJ Open"},{"key":"2026092904322996100_zrag111-B12","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1186\/s13063-021-05202-y","article-title":"Enhanced PeriOperative Care and Health protection programme for the prevention of surgical site infections after elective abdominal surgery (EPO2CH): statistical analysis plan of a randomised controlled multicentre superiority trial","volume":"22","author":"de Jonge","year":"2021","journal-title":"Trials"},{"key":"2026092904322996100_zrag111-B13","doi-asserted-by":"crossref","first-page":"101448","DOI":"10.1016\/j.lanepe.2025.101448","article-title":"A care bundle added to standard care versus standard care for the prevention of surgical site infections after abdominal surgery (EPO2CH trial): a randomised, open label, pragmatic, superiority multicentre trial","volume":"58","author":"Wolfhagen","year":"2025","journal-title":"Lancet Reg Health Eur"},{"key":"2026092904322996100_zrag111-B14","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12916-021-02204-0","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"20","author":"Husereau","year":"2022","journal-title":"BMC Med"},{"key":"2026092904322996100_zrag111-B15","author":"Zorginstituut Nederland"},{"key":"2026092904322996100_zrag111-B16","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1001\/jamasurg.2017.0904","article-title":"Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017","volume":"152","author":"Berr\u00edos-Torres","year":"2017","journal-title":"JAMA Surg"},{"key":"2026092904322996100_zrag111-B17","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1086\/646436","article-title":"CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections","volume":"13","author":"Horan","year":"1992","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2026092904322996100_zrag111-B18","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1002\/hec.1363","article-title":"The impact of using different costing methods on the results of an economic evaluation of cardiac care: microcosting vs gross-costing approaches","volume":"18","author":"Clement Nee Shrive","year":"2009","journal-title":"Health Econ"},{"key":"2026092904322996100_zrag111-B19","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s10198-004-0259-9","article-title":"Collecting unit cost data in multicentre studies. Creating comparable methods","volume":"6","author":"Wordsworth","year":"2005","journal-title":"Eur J Health Econ"},{"key":"2026092904322996100_zrag111-B20","volume-title":"Manual iMTA Medical Cost Questionnaire (iMCQ)","author":"iMTA Productivity and Health Research Group","year":"2018"},{"key":"2026092904322996100_zrag111-B21","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.jval.2015.05.009","article-title":"The iMTA productivity cost questionnaire: a standardized instrument for measuring and valuing health-related productivity losses","volume":"18","author":"Bouwmans","year":"2015","journal-title":"Value Health"},{"key":"2026092904322996100_zrag111-B22","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/0167-6296(94)00044-5","article-title":"The friction cost method for measuring indirect costs of disease","volume":"14","author":"Koopmanschap","year":"1995","journal-title":"J Health Econ"},{"key":"2026092904322996100_zrag111-B23","unstructured":"Centraal Bureau voor de Statistiek . Jaarmutatie consumentenprijsindex; vanaf 1963. 2024. https:\/\/opendata.cbs.nl\/#\/CBS\/nl\/dataset\/70936NED\/table?fromstatweb (accessed 17 July 2026)"},{"key":"2026092904322996100_zrag111-B24","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3109\/07853890109002087","article-title":"EQ-5D: a measure of health status from the EuroQol Group","volume":"33","author":"Rabin","year":"2001","journal-title":"Ann Med"},{"key":"2026092904322996100_zrag111-B25","first-page":"1574","article-title":"Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff","volume":"149","author":"Lamers","year":"2005","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2026092904322996100_zrag111-B26","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s10151-024-02932-4","article-title":"The economic impact of anastomotic leakage after colorectal surgery: a systematic review","volume":"28","author":"Nijssen","year":"2024","journal-title":"Tech Coloproctol"},{"key":"2026092904322996100_zrag111-B27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jhin.2017.03.004","article-title":"Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries","volume":"96","author":"Badia","year":"2017","journal-title":"J Hosp Infect"},{"key":"2026092904322996100_zrag111-B28","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.jhin.2019.07.010","article-title":"Burden of surgical site infections in The Netherlands: cost analyses and disability-adjusted life years","volume":"103","author":"Koek","year":"2019","journal-title":"J Hosp Infect"},{"key":"2026092904322996100_zrag111-B29","first-page":"857","article-title":"The burden of health care utilization, cost, and mortality associated with select surgical site infections","volume":"50","author":"Shambhu","year":"2024","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"2026092904322996100_zrag111-B30","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/DCR.0000000000003478","article-title":"Impact of anastomotic leakage after colorectal cancer surgery on quality of life: a systematic review","volume":"68","author":"Gielen","year":"2025","journal-title":"Dis Colon Rectum"},{"key":"2026092904322996100_zrag111-B31","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1097\/DCR.0000000000000040","article-title":"Do anastomotic leaks impair postoperative health-related quality of life after rectal cancer surgery? A case-matched study","volume":"57","author":"Marinatou","year":"2014","journal-title":"Dis Colon Rectum"},{"key":"2026092904322996100_zrag111-B32","first-page":"325","article-title":"The impact of postoperative complications on short-and long-term health-related quality of life after total mesorectal excision for rectal cancer","volume":"21","author":"van Kooten","year":"2022","journal-title":"Clin Colorectal Cancer"},{"key":"2026092904322996100_zrag111-B33","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1089\/sur.2016.132","article-title":"How long is long enough to identify a surgical site infection?","volume":"18","author":"Holihan","year":"2017","journal-title":"Surg Infect (Larchmt)"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag111\/71457823\/zrag111.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/5\/zrag111\/71457823\/zrag111.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T08:32:44Z","timestamp":1790670764000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag111\/8844295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":33,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9,4]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag111","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,4]]},"article-number":"zrag111"}}