Abstract: Objective To explore the direct economic burden of nosocomial infections in patients after neurosurgery and the impact on the length of hospital stay, in order to provide an economic reference for the formulation of relevant prevention and control measures. Methods A total of 1,487 patients who underwent surgical treatment in the neurosurgery department of a tertiary hospital in Shandong Province during Jan. 1 and Dec. 31, 2020 were enrolled. The patients were divided into the infection group and non-infection group. The direct financial burden and length of hospital stay of patients were analyzed with 1∶1 propensity score matching method(caliper value was 0.02, non-replacer sampling was used)and Wilcoxon rank-sum test. Results Nosocomial infections occurred in 228 patients, the infection rate was 15.33%, and the propensity score matched 228 pairs successfully. Before matching, the median hospitalization costs of the non-infection group and infection group were 50 971.40 yuan and 65 739.67 yuan, respectively, and the median hospitalization time was 17 days and 23 days, respectively. After matching, the median hospitalization costs were 52 177.10 yuan in the non-infection group, and 65 739.67 yuan in the infection group, which was 13 562.57 yuan higher. Other medical expenses were also higher in the infection group, especially the costs of Western medicine(Z=-16.864, P<0.001). The length of hospital stay was 17 days in the non-infection group, and 24 days in the infection group, which was 7 days longer(Z=-11.532, P<0.001). The total hospitalization costs, bed fees, diagnosis and treatment fees, examination fees, treatment fees, laboratory tests fees, nursing fees, Western medicine fees, and sanitary materials fees were statistically different among all types of hospital infections(P<0.05). However, there was no significant difference in operating expenses and length of hospital stay(P>0.05). The total hospitalization costs were the highest in patients with surgical site infection and lung infection. Conclusion The rate of nosocomial infection after neurosurgery is relatively high, which prolongs the length of hospital stay and increases the economic burden on patients. In addition, patients with multiple infections suffer the most. Nosocomial infection managers should formulate effective plans to prevent nosocomial infections to improve the prognosis of patients, reduce the economic burden of hospitalization, and increase the utilization of medical resources.

Key words: Neurosurgery, Hospital infection, Economic burden, Length of hospital stay