| Abstract: |
Pragmatic interventional study to analyze the implementation and outcomes of a colorectal surgery care bundle within a nationwide quality improvement program. The bundle consisted of antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation, laparoscopy, normothermia, and a wound retractor. Control group (CG) and Intervention group (IG) were compared. Overall SSI, superficial (S-SSI), deep (D-SSI), and organ/space (O/S-SSI) rates were analyzed. Secondary endpoints included microbiology, 30-day mortality, and length of hospital stay. A total of 37 849 procedures were included, 19 655 in the CG and 18 194 in the IG. In all, 5462 SSIs (14. 43%) were detected: 1767 S-SSI (4. 67%), 847 D-SSI (2. 24%), and 2838 O/S-SSI (7. 5%). Overall SSI fell from 18. 38% (CG) to 10. 17% (IG), odds ratio (OR) of 0. 503 [0. 473-0. 524]. O/S-SSI rates were 9. 15% (CG) and 5. 72% (IG), OR of 0. 602 [0. 556-0. 652]. The overall SSI rate was 16. 71% when no measure was applied and 6. 23% when all six were used. Bundle implementation reduced the probability of overall SSI (OR: 0. 331; CI: 0. 242-0. 453), and also O/S-SSI rate (OR: 0. 643; CI: 0. 416-0. 919). In the univariate analysis, all measures except normothermia were associated with a reduction in overall SSI, while only laparoscopy, OAP, and mechanical bowel preparation were related to a decrease in O/S-SSI. Laparoscopy, wound retractor, and OAP decreased overall SSI and O/S-SSI in the multivariate analysis. In this cohort study, the application of a specific care bundle within a nationwide nosocomial infection surveillance system proved feasible and resulted in a significant reduction in overall and O/S-SSI rates in the elective colon and rectal surgery. The OR for SSI fell between 1. 5 and 3 times after the implementation of the bundle. |
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(Universitat Internacional de Catalunya)
