Direct Medical Costs and Length of Stay Associated with Postoperative Bloodstream Infections in Gynecologic Surgery: A Propensity Score-Matched Case-Control Study

Background The economic burden of post-operative bloodstream infection (PBSI) in gynecologic surgery is poorly understood. This study aimed to quantify the impact of PBSI on direct medical costs and length of stay (LOS) for patients undergoing gynecologic procedures. Methods A retrospective case-control study was performed in a tertiary hospital in China, which included patients who received gynecologic surgery between January 2022 and December 2024. A 1:3 propensity-score matching (PSM) was applied to account for baseline characteristics of patients with PBSI (the case group) and patients without PBSI (the control group). The primary outcomes were direct medical costs and LOS. Results Following PSM, a total of 203 cases and 609 controls were analyzed, with baseline covariates well-balanced. Total medical costs were significantly higher in the case group compared to controls (€3779.94 vs. €2130.49; p  < 0.001), with a median difference of €1446.59. Patients with PBSI also incurred a longer overall LOS (12 vs. 6 days; p  < 0.001) entirely driven by a longer post-operative LOS (9 vs. 4 days; p  < 0.001). These findings were consistent across surgery types. Conclusions PBSI following gynecologic surgery substantially increases direct medical costs and prolongs LOS. These findings highlight the significant economic and resource burden of this complication. Implementing and investing in effective PBSI prevention strategies is critical for improving patient outcomes, reducing healthcare expenditures, and optimizing resource utilization.