Fiona Gaunay, MD, Titi Adegboyega, MD, MPH, Cesar Sanz, MD, Marco Beronnes, PAC, David Rivadeneira, MD, MBA. Northwell Health System, Hofstra University School of Medicine
Introduction: Surgical site infections (SSIs) represent significant morbidity and financial burden following colon surgery. The objective of this prospective study is to compare clinical outcomes pre- and post- implementation of a dedicated colon surgery bundle to reduce SSIs in our health system.
Methods: A prospective study was conducted in which a dedicated colon surgery bundle and interdisciplinary team for its implementation was established. The twenty-five components of the colon surgery bundle were divided into pre-hospital, pre, intra, and post-operative measures. These included standardized pre-operative mechanical bowel preparation and oral antibiotics, body wash skin cleansing, alcohol-based skin preparation, intra- and peri-operative maintenance of normothermia, therapeutic levels of antimicrobial prophylaxis, optimal tissue oxygenation, glucose control, the introduction of a clean standardized fascial closure process, and negative pressure wound therapy. Specific enhanced pre-operative patient education was also provided. Consecutive patients who underwent a colorectal procedure between January 2015 and January 2016 were included. SSIs were recorded and subdivided by surgical wound class.
Results: SSIs were identified in 11/198 patients (7%) eligible for colon bundle implementation. When compared to the year prior to implementation of the colon bundle, SSIs where identified in 26/175 (15%). Implementation of the colon bundle led to a significant decrease in SSIs 7% vs. 15%, (p <0.05). Additionally, SSIs observed in clean-contaminated and contaminated procedures decreased from 34.6% to 14.3% and 38.5% to 14.3%, respectively (p<0.05).
Conclusion: We demonstrate in this prospective study that the implementation of a specific colon bundle resulted in a 54% decrease in post-operative SSIs. The greatest reduction of SSIs was seen in wound classes II and III. We also show a very high adoption and compliance of the colon bundle with a dedicated implementation of an interdisciplinary team. This approach to incorporating an advanced surgery bundle for colon and rectal procedures can provide an effective strategy to reduce SSIs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79547
Program Number: S140
Presentation Session: Colorectal 2
Presentation Type: Podium