Slide 1: The Cost of Surgical Site Infections
The Cost of Surgical Site Infections PolyPid KOL Event June 2022
Slide 2: Disclaimer
Disclaimer This presentation of PolyPid Ltd. (the “Company”) contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act and other securities laws. Words such as “expects,” “anticipates,” “intends,” “plans,” “believes,” “seeks,” “estimates” and similar ex
Slide 3: Agenda
Agenda 01 Introduction 02 The cost of SSI: a surgeon’s view – Dr. Kyle Cologne 03 The cost of SSI: a hospital administration view – Dr. Elliot Goodman 04 Company updates 05 Q&A 3
Slide 4: Surgical site infections have significant clinical and economic impact on patients and hospitals
Surgical site infections have significant clinical and economic impact on patients and hospitals SSI impact on patient outcomes… … has direct economic impact on hospitals 7-11 days additional post-operative hospital days Cost of prevention and treatment of SSI 2-11x increased risk of death (up to 40
Slide 5: Today's speakers
Today’s speakers Kyle Cologne, MD completed his general surgery training in Chicago at Rush University and Cook County Medical Centers, followed by a fellowship in Colon and Rectal Surgery at the University of Southern California, where he joined the faculty in 2012. He is the current fellowship dir
Slide 6: Today's speakers
Today’s speakers Elliot Goodman, MD was born in London and educated at the University of Cambridge. After one year of postgraduate training in Cambridge and London, he moved to the United States in 1990 and trained as a general surgeon at Maimonides Medical Center in Brooklyn, New York . During this
Slide 7: Surgical Site Infections (SSIs): By the Numbers
SURGICAL SITE INFECTIONS (SSIS): BY THE NUMBERS KYLE G. COLOGNE, MD, FACS, FASCRS ASSOCIATE PROFESSOR OF SURGERY VICE-CHAIR, SURGICAL QUALITY COMMITTEE USC DIVISION OF COLORECTAL SURGERY
Slide 8: Learning Objectives
Learning Objectives 1. Understand the financial implications for SSI 2. Describe specific opportunities improvement in SSI
Slide 9: The Problem:
+ %. wi ah THE PROBLEM:
Slide 10: How bad is it: overall rate SSI 6-26%
HOW BAD IS IT: • OVERALL RATE SSI: 6-26% (LOW AND HIGH OUTLIERS) • IT IS GETTING WORSE: • CALIFORNIA REPORTED A 6% INCREASE IN COLON SURGERY SSI BETWEEN 2008 (NATIONAL BASELINE) AND 2014 AND AN INCREASE OF 28% FROM 2013 TO 2014 CDC’S ANNUAL INFECTIONS PROGRESS REPORT (HAI PROGRESS REPORT) (2014 HTTP
Slide 11: Why It Matters: Front End Back End
WHY IT MATTERS: Front End Back End
Slide 12: Why It Matters: Costs More
WHY IT MATTERS: COSTS MORE OVERALL: $10 BILLION COST TO HEALTHCARE SYSTEM Ban KA. J Am Coll Surg 2017 Leaper DJ. Dis Colon Rectum 2020
Slide 13: Biggest cost drivers of healthcare: length of stay, complications
2 BIGGEST COST DRIVERS OF HEALTHCARE: LENGTH OF STAY COMPLICATIONS
Slide 14: Results: Reasons for prolonged LOS
RESULTS: • Reasons for prolonged (>10 day) LOS: Factor Odds Ratio 95% CI p-value American Society of Anesthesiology 2.152 1.245 to 3.721 0.019 (ASA) score Anastomotic leak 2.163 1.486 to 3.148 <0.001 Ileus 8.790 4.501 to 17.165 <0.001 Surgical site infection 2.764 to 12.362 <0.001 5.846 Cancer diagn
Slide 15: The Numbers: LOS and complications costs
THE NUMBERS: • LOS (+$1,500 - $3,800 / DAY) (Profit Margin: $3,288 • COMPLICATIONS (+$ 19,000 )1 withOUT complications increased overall vs. $755) 2 WITH complications -$2,533 1) Healy MA. JAMA Surg 2016. 2) Dimick JB. J Am Coll Surg 2006.
Slide 16: Why It Matters: Reimburses Less
WHY IT MATTERS: REIMBURSES LESS
Slide 17: So What Are We Doing About It?
SO WHAT ARE WE DOING ABOUT IT?
Slide 18: The Preventive Surgical Site Infection Bundle in Colorectal Surgery
The Preventive Surgical Site Infection Bundle in Colorectal — Surgery An Effective Approach to Surgical Site Infection Reduction and Health Care Cost Savings Figure 1. The Preventive Surgical Site Infection (SSI) Bundle in Colorectal Surgery Preoperative Operative Postoperative Chlorhexidine shower
Slide 19: Does It Work?
DOES IT WORK? by avoiding SSI Leaper DJ. Dis Colon Rectum 2020
Slide 20: Potential for Cost Savings
POTENTIAL FOR COST SAVINGS: by avoiding SSI $10 BILLION COST TO HEALTHCARE SYSTEM
Slide 21: kyle.cologne@med.usc.edu
kyle.cologne@med.usc.edu BEST = : 5 HOSPITALS Se 2 WORLD REPORT LE INC V' : BEST HONOR ROLL REST HOSPITALS HOSPITALS
Slide 22: The economics of SSIs after colorectal surgery
The economics of SSIs after colorectal surgery: Elliot R Goodman MD, Associate Director for Surgical Quality, Mount Sinai Health System.
Slide 23: Few basic facts
Few basic facts: ● 158,000 patients get SSIs after all surgical procedures in USA each year (ASCRS data, 2019). ● Total cost of treating these SSIs - $3.1B (approx. $20,000/patient) ● Approximately 300,000 colorectal procedures performed in USA each year (Leaper, 2020) ● Range of reported incidence
Slide 24: Definition of SSI in CRS
Definition of SSI in CRS (as per CDC and NHSN): ● Superficial incisional SSI ● Deep incisional SSI ● Organ/space SSI
Slide 25: Who monitors SSIs after CRS?
Who monitors SSIs after CRS? ● Rate of SSI is a KPI of hospital surgical services ● Publicly available data ● May be tracked, reported and publicized by hospitals themselves, by State DoHs, payers inc. CMS, third-party watch dogs (e.g. Leapfrog, Healthgrades)
Slide 26: Who monitors SSIs after CRS?
Who monitors SSIs after CRS? ● Hospitals themselves for internal quality improvement - from ICD-10/DRG codes and billing data ● Govt agencies such as National Healthcare Safety Network [NHSN] and Agency for Healthcare Research and Quality [AHRQ] gather data from hospitals and report SSIs to CMS (may
Slide 27: Who monitors SSIs after CRS?
Who monitors SSIs after CRS? ● NHSN and AHRQ data - not risk adjusted, only report in-patient SSIs (missing 50% of SSIs diagnosed post-discharge) and do not include superficial incisional SSIs ● NSQIP - risk adjusted for patient acuity/comorbidities, includes in- and out- patient diagnoses of SSI bu
Slide 28: Who monitors SSIs after CRS?
Who monitors SSIs after CRS? Assessment: needs improvement, as expected, exemplary Colectomy SSI Proctectomy SSI ACS NSQIP semi-annual report 2020
Slide 29: Who monitors SSIs after CRS? NYS Department of Health
Who monitors SSIs after CRS? NYS Department of Health [DoH] HAI surveillance program (since 2007): Data obtained directly [by mandate] from hospitals and 2019 NYS indirectly from Federal sources (NHSN/CDC) DoH data
Slide 30: NYS DoH HAI surveillance program: 2019 data
NYS DoH HAI surveillance program: 2019 data
Slide 31: What have we done to reduce risk of CRS SSIs?
What have we done to reduce risk of CRS SSIs? ● CMS Surgical care improvement program ● These measures have reduced SSI (SCIP, 2002) - single perioperative rates by 40-55% in various meta- checklist designed by CMS to align analyses (Turner and Migaly, 2019) surgical quality to reimbursement ● Cost
Slide 32: What have we done to reduce risk of CRS SSIs?
What have we done to reduce risk of CRS SSIs?
Slide 33: The economic cost of SSI after CRS
The economic cost of SSI after CRS: ● Leaper 2020 study: retrospective observational cohort analysis of 108,000 patients undergoing CRS in USA 2014-2018 ● Followed patients for 24 months after surgery ● 4% incidence of superficial incisional SSI ● 20% incidence of deep incisional or organ space SSI
Slide 34: The economic cost of SSI after CRS
The economic cost of SSI after CRS: ● Leaper study: large, long-duration (24 months) longitudinal study ● Better assessment of incidence and cost of SSI after CRS than previous smaller and shorter-duration studies which probably underestimated both incidence and economic cost of SSI (7-10%, $12-42,0
Slide 35: The economic cost of SSI after CRS - value based purchasing (VBP)
The economic cost of SSI after CRS - value based purchasing (VBP):
Slide 36: The economic cost of SSI after CRS - value based purchasing
The economic cost of SSI after CRS - value based purchasing: ● Payers such as CMS now use KPIs such as rate of SSIs and other hospital-acquired infections (HAIs) to make VBP decisions ● CMS can reduce payment by up to 6% if best practice guidelines are not met e.g. hospital is in lowest quartile for
Slide 37: Conclusions
Conclusions: ● SSI after CRS is common and causes significant postoperative morbidity ● SSI adds greatly to the cost and length of care and can reduce payer reimbursement to hospitals ● Rates of SSI after CRS are reportable events and can become publicly available data points ● Hospital reputations
Slide 38: References
References: ● Leaper, D. et al (2020): Assessment of the Risk and Economic Burden of Surgical Site Infection Following Colorectal Surgery Using a US Longitudinal Database: Is There a Role for Innovative Antimicrobial Wound Closure Technology to Reduce the Risk of Infection? Diseases of the Colon & R
Slide 39: Company updates
Company updates POLY PID
Slide 40: Recent market research suggest that 40% of all in-patient colorectal resection procedures are performed on high-risk patients
Recent market research suggest that 40% of all in-patient colorectal resection procedures are performed on high-risk patients Number of patients split by type of surgery and patient risk 610 COLON/BOWEL RESECTION 520 # Inpatient 90 # Outpatient 212 # Open Procedure 308 # MIS Procedure 5 # Open Proce
Slide 41: Recent and upcoming milestones
Recent and upcoming milestones ▪ Data Safety Monitoring Board recently recommended concluding study at 950 patients, the minimum number of patients targeted ▪ Last-patient-in was announced on May 31 ▪ A total of 977 patients enrolled in the trial - the largest trial in colorectal surgery infection p
Slide 42: Q&A
Q&A POLY PID