Preventive surgical site infection bundle reduced colorectal surgery-related infections

A preventive surgical site infection bundle was associated with significant reductions in surgical site infections after colorectal surgery, according to new research.

“About 6 years ago we found that we had a significantly elevated surgical site infection (SSI) rate,” Christopher R. Mantyh, MD, department of surgery at Duke University Medical Center, told Healio.com/Gastroenterology. “What we tried to do was come up with a series of ways to prevent [SSIs] preoperatively, interoperatively and postoperatively, and we called this our [SSI] bundle prevention package.”

Mantyh and colleagues then performed a retrospective cohort study of institutional clinical and cost data to assess the effect the bundle measures had on SSI rate and health care costs associated with colorectal surgery (CRS). The bundle’s components included evidence-based and common-sense initiatives to standardize surgery preparation and surgical, sanitary and after-care practices.

Using data from the American College of Surgeons National Surgical Quality Improvement Program, researchers identified 559 patients undergoing major CRS at Duke University Medical Center from 2008 through 2012. They compared outcomes before (n=346) and after (n=213) implementation of the preventive SSI bundle on July 1, 2011. Groups were propensity-matched to account for pre- and post-implementation differences.

Bundle implementation reduced superficial SSIs from 19.3% to 5.7% (P<.001) and postoperative sepsis from 8.5% to 2.4% (P=.009). In a subgroup analysis of the post-implementation group, incidence of superficial SSI was associated with a 35.5% increase in variable direct costs (P=.001) and a 71.7% increase in length of stay (P<.001).

Elizabeth C. Wick

Comparing patients before and after bundle implementation showed “a very significant drop in our [SSI] rate,” Mantyh said, “and our rate has remained low over the last few years. When we did a propensity matching score we actually did see that there was a reduction in costs … as well as a reduction in length of stay, and over the last 2 years, our length of stay has been decreased by about 2.5 days for our colectomy patients.”

In a related editorial, Ira L. Leeds, MD, MBA, and Elizabeth C. Wick, MD, from the department of surgery at Johns Hopkins University, wrote that this and other recent studies “support that colorectal [SSI] is a preventable harm with adherence to published evidence, best practice guidelines, and culture change. In all of these studies, significant [SSI] reduction stems from implementation of processes that span the continuum of care from before surgery through postoperative recovery, and these interventions are far more complex than the Surgical Care Improvement Program measures now held as the gold standard for surgical quality reporting.” Because of CRS’ unique characteristics, they added, “wide applicability exists outside of the specialty.”

Disclosure: The researchers report no relevant financial disclosures.

For more information:

Keenan JE. JAMA Surg. 2014;doi:10.1001/jamasurg.2014.346.

Leeds IL. JAMA Surg. 2014;doi:10.1001/jamasurg.2014.389.