Comparison of two bundles for reducing surgical site infection in colorectal surgery : multicentre cohort study
Flores-Yelamos, Miriam (Universitat Internacional de Catalunya)
Gomila, Aina (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Badia, Josep M. (Universitat Internacional de Catalunya)
Almendral, Alexander (Generalitat de Catalunya)
Parés, David (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Pascual, Marta (Hospital del Mar (Barcelona, Catalunya))
Limón, Enric (Universitat de Barcelona)
Pujol, Miquel (Hospital Universitari de Bellvitge)
Juvany, Montserrat (Hospital del Mar (Barcelona, Catalunya))

Data:	2024
Resum:	There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level. A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after the sequential implementation of two preventive bundle protocols. Secondary outcomes were to determine compliance with individual measures and to establish their effectiveness, duration of stay, microbiology and 30-day mortality rate. A total of 32 205 patients were included. A 50% reduction in surgical site infection was achieved after the implementation of two sequential sets of bundles: from 18. 16% in the Baseline group to 10. 03% with Bundle-1 and 8. 19% with Bundle-2. Bundle-2 reduced superficial-surgical site infection (OR 0. 74 (95% c. i. 0. 58 to 0. 95); P = 0. 018) and deep-surgical site infection (OR 0. 66 (95% c. i. 0. 46 to 0. 93); P = 0. 018) but not organ/space-surgical site infection (OR 0. 88 (95% c. i. 0. 74 to 1. 06); P = 0. 172). Compliance increased after the addition of four measures to Bundle-2. In the multivariable analysis, for organ/space-surgical site infection, laparoscopy, oral antibiotic prophylaxis and mechanical bowel preparation were protective factors in colonic procedures, while no protective factors were found in rectal surgery. Duration of stay fell significantly over time, from 7 in the Baseline group to 6 and 5 days for Bundle-1 and Bundle-2 respectively (P < 0. 001). The mortality rate fell from 1. 4% in the Baseline group to 0. 59% and 0. 6% for Bundle-1 and Bundle-2 respectively (P < 0. 001). There was an increase in Gram-positive bacteria and yeast isolation, and reduction in Gram-negative bacteria and anaerobes in organ/space-surgical site infection. The addition of measures to create a final 10-measure protocol had a cumulative protective effect on reducing surgical site infection. However, organ/space-surgical site infection did not benefit from the addition. No protective measures were found for organ/space-surgical site infection in rectal surgery. Compliance with preventive measures increased from Bundle-1 to Bundle-2. A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after sequential application of two preventive bundle protocols. A 50% reduction in surgical site infections was achieved in a cohort of 32 205 patients after sequential application of the bundles. The addition of four supplementary measures to create a final 10-measure protocol increased compliance, but only incisional surgical site infections benefited from the addition, while organ/space-surgical site infections did not.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	BJS Open, Vol. 8 (august 2024) , ISSN 2474-9842

DOI: 10.1093/bjsopen/zrae080
PMID: 39107075

12 p, 257.6 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d’Investigació i Innovació Parc Taulí (I3PT)
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