Developing an argument for bundled interventions to reduce surgical site infection in colorectal surgery

doi:10.1016/j.surg.2013.12.004

Surgery

Volume 155, Issue 4, April 2014, Pages 602-606

https://doi.org/10.1016/j.surg.2013.12.004 Get rights and content

Background

Surgical site infection (SSI) remains a costly and morbid complication after colectomy. The primary objective of this study was to investigate whether a group of perioperative care measures previously shown to be associated with reduced SSI would have an additive effect in SSI reduction. If so, this would support the use of an “SSI prevention bundle” as a quality improvement intervention.

Methods

Data from 24 hospitals participating in the Michigan Surgical Quality Collaborative were included in the study. The main outcome measure was SSI. Hierarchical logistic regression was used to account for clustering of patients within hospitals.

Results

In total, 4,085 operations fulfilled inclusion criteria for the study (Current Procedural Terminology codes 44140, 44160, 44204, and 44205). A “bundle score” was assigned to each operation, based on the number of perioperative care measures followed (appropriate Surgical Care Improvement Project-2 antibiotics, postoperative normothermia, oral antibiotics with bowel preparation, perioperative glycemic control, minimally invasive surgery, and short operative duration). There was a strong stepwise inverse association between bundle score and incidence of SSI. Patients who received all 6 bundle elements had risk-adjusted SSI rates of 2.0% (95% confidence interval [CI], 7.9–0.5%), whereas patients who received only 1 bundle measure had SSI rates of 17.5% (95% CI, 27.1–10.8%).

Conclusion

This multi-institutional study shows that patients who received all 6 perioperative care measures attained a very low, risk-adjusted SSI rate of 2.0%. These results suggest the promise of an SSI reduction intervention for quality improvement; however, prospective research are required to confirm this finding.

Section snippets

Setting

This is a retrospective cohort study from the MSQC, a voluntary network of 52 hospitals that collect data on surgical patients for the purpose of quality improvement. Twenty-four MSQC hospitals participated in the Colectomy Project, a focused effort to improve SSI in colectomy operations across the collaborative from 2008 to 2011. The MSQC is funded by Blue Cross Blue Shield of Michigan, a private, not-for-profit insurance company. Although Blue Cross Blue Shield provides financial support for

Results

Within the 24 Michigan hospitals participating in the colectomy project, 4,085 colectomy operations were performed during the study period.

The Table depicts demographic characteristics between the compliance groups. Before patient- and hospital-level risk adjustment, body mass index, age >70 years, wound class, functional status, race, presence of open wound, American Society of Anesthesiologists class, albumin, and history of colon cancer were found to be significantly different when compared

Discussion

Postoperative SSI is a common and morbid complication for patients after colectomy. Although the MSQC had initially focused on quality improvement through individual interventions, we wanted to build a case for bundling interventions to improve compliance and more efficiently reduce SSI. Previous studies considering bundled measures for prevention of SSI have not conclusively demonstrated the efficacy of these interventions.9, 10 In this study, we sought to demonstrate the potential of a bundle

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Original CommunicationDeveloping an argument for bundled interventions to reduce surgical site infection in colorectal surgery

Background

Methods

Results

Conclusion

Section snippets

Setting

Results

Discussion

Am J Surg

J Hosp Infect

Am J Surg

J Am Coll Surg

Am J Infect Control

Jt Comm J Qual Patient Saf

A statewide consortium of surgical care: a longitudinal investigation of vascular operative procedures at 16 hospitals

Surgery

Antibiotic choice is independently associated with risk of surgical site infection after colectomy: a population-based cohort study

Ann Surg

Surgical site infections and cost in obese patients undergoing colorectal surgery

Arch Surg

Original Communication
Developing an argument for bundled interventions to reduce surgical site infection in colorectal surgery