To determine the impact of infection (INF) on medical resource utilization (MRU) and cost of care in venous leg ulcer (VLU) patients.

We performed a retrospective case-controlled study of 78 patients followed for a minimum of 12 months with C6 VLUs treated by vascular surgeons, at our wound center. To eliminate either minor episodes of INF or incorrectly diagnosed episodes, only patients who had an inpatient admission specifically for INF comprised the INF GROUP, while all other admissions were excluded for this group. Medical Resource Utilization (MRU) was defined as: the number of clinic visits; visiting nurse (VNA) visits, and inpatient admissions. The actual cost for treatment was determined using financial data provided by both the hospital and physician organization billing units. The total cost over the 1 year follow up period was comprised of individual cost centers: inpatient and outpatient facility fees, physician fees, and visiting nurse services. Mean MRU and cost data were compared using the two-sample t test between INF and NON-INF.

Of the 78 C6 VLU patients 9 (11.5%) had at least one inpatient admission for INF related to their VLU in the 1-year treatment period, with an additional five recurrent admissions for a total of 14 admissions, while 69 NON-INF had 3 non infection related admissions. There was no difference between INF and NON-INF for usual risk factors, but INF had a greater proportion of CHF (44%; 13% , p < 0.02). Regarding MRU: both the number of outpatient wound center visits (INF 16.89 +/- 6.41; NON-INF 9.46 +/- 7.7, P=0.008) and VNA blocks (INF 3.89 +/- 2.93; NON=INF 1.94 +/- 2.24, p < 0.02) were greater for INF. Total costs for INF ($27,408 +/- $10,859) were threefold higher than for NON-INF ($11,088 +/- 9,343, p< 0.0001) and subsequent VNA costs were doubled for INF ($9,956 +/- $4,657) versus NON-INF ($4,657 +/- 5,486, p = 0.01)).

Infections in VLU patients led to an overall increase in MRU and cost of care; with the INF cohort requiring both more inpatient admissions, outpatient visits, and VNA services than NON-INF. Given the major impact INF has on cost and MRU, better treatment modalities that prevent infection as well as identifying risk factors for INF in VLU patients are needed.