A novel prevention bundle to reduce incisional infections after radical cystectomy

Ross, James; Breau, Rodney H.; McAlpine, Kristen; Rowe, Neal; Williams, Lara; Knee, C. Raymond; Cagiannos, Ilias; Morash, Christopher; Mallick, Ranjeeta; Walraven, Carl van; Lavallée, Luke T.

doi:10.1016/j.urolonc.2020.04.016

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…Ross et al recently published results from an interventional initiative intended to decrease SSIs after open radical cystectomy (ORC). The intervention included application of wound protection (Alexis retractor), exchange of gowns and gloves prior to fascial closure, irrigation of the subcutaneous tissue with a mixture of saline/proviodine prior to skin closure, and usage of antibiotic-impregnated dressings [12 ▪ ]. These measures, possibly with the additional effect of the increased attention to other details that can prevent infections that is inherent in such study settings, resulted in a decrease in SSI from 16.5% to 2.4% post intervention.…”

Section: Postoperative Infectionsmentioning

confidence: 99%

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Bobjer

2021

Current Opinion in Urology

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Purpose of reviewUrinary diversion (UD) with or without cystectomy is a procedure with high short term complication rates. In this review, we summarize the most relevant findings of the last 2 years.Recent findingsThe use of a prophylactic mesh decreases the risk of parastomal hernia after ileal conduit (IC) surgery without adding mesh-related complications according to a recent randomized multicentre trial. Robot-assisted surgery is increasingly applied for UD and is evolving from extra- to intra-corporeal reconstruction in both continent and incontinent diversions, but there is still a need for appropriately designed studies assessing both short- and long-term complications. Promising techniques to decrease ureterointestinal stricture rates have been reported from small series, such as retrosigmoid placement of the proximal IC to avoid transpositioning of the left ureter, or in robot-assisted surgery the use of indocyanine green with near-infrared light to improve visualisation of distal ureteral viability.SummaryMost recent reports derive from observational data. Appropriate randomized studies are warranted for the evaluation of new techniques to be implemented in a surgical area that still is associated with high complication rates.

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Section: Postoperative Infectionsmentioning

confidence: 99%

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Bobjer

2021

Current Opinion in Urology

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“…Previously, we reported a simple intraoperative intervention bundle with wound barrier that reduced SSIs by 80%. 14 Pre-operative prophylactic antimicrobials have been shown to reduce post-operative infection in surgery, however, cystectomy specific data are lacking. The American Urology Association (AUA) and European Association of Urology (EAU) recommend that patients undergoing radical cystectomy and diversion receive antimicrobial prophylaxis based on colorectal surgery data.…”

Section: Introductionmentioning

confidence: 99%

“…The impact of the SSI prevention bundle was previously reported. 14 Use of the SSI prevention bundle did not impact antimicrobial regimen choice and it was included in the multivariable analysis to adjust for possible confounding.…”

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confidence: 99%

Association between radical cystectomy prophylactic antimicrobial regimen and postoperative infection

Ross

Breau

Vigil

et al. 2021

CUAJ

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Introduction: Infections are common after radical cystectomy. The objective of this study was to determine the association between antimicrobial prophylactic regimen and infection after radical cystectomy. Methods: A retrospective cohort study was performed on patients who underwent radical cystectomy at one tertiary Canadian center between January 2016 and April 2020. Patients received antimicrobial prophylaxis based on surgeon preference (cefazolin/metronidazole or ampicillin/ciprofloxacin/metronidazole or other). A univariable and multivariable logistic regression model was created to determine the association between antimicrobial regimen and postoperative infection within 30 days. The association between patient demographic factors, as well as preoperative and intraoperative variables and infection was also determined. Infection characteristics, including type, timing, and antimicrobial susceptibilities were reported. Results: One hundred and sixty-five patients were included. Mean age was 69.8 years, 121 (73.3%) were male, and 72 (43.6%) received orthotopic neobladder diversion. Ninety-six patients (58%) received cefazolin/metronidazole prophylaxis, 50 (30%) received ampicillin/ciprofloxacin/metronidazole, and 19 (11.5%) received another regimen. Fifty-four patients (32.7%) developed a postoperative infection (surgical site infection or urinary tract infection). Surgical site infection occurred in 35 patients (21.2%) and urinary tract infection occurred in 34 (21.0%). There was no association between antimicrobial regimen and incidence of postoperative infection (surgical site infection or urinary tract infection, relative risk [RR] 0.99, 95% confidence interval [CI] 0.50–1.99). Conclusions: The overall incidence of infection was 32.7% following radical cystectomy. The preoperative prophylactic antibiotic regimen used was not associated with incidence of postoperative infection.

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Translation of Evidence-Based Interventions Into Oncology Care Settings

et al. 2022

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Background: Adoption of evidence remains slow, leading to variations in practices and quality of care. Examining evidence-based interventions implemented within oncology settings can guide knowledge translation efforts. Objective: This integrative review aimed to (1) identify topics implemented for oncology-related evidence-based practice (EBP) change; (2) describe frameworks, guidelines, and implementation strategies used to guide change; and (3) evaluate project quality. Methods: PubMed and CINAHL were searched to identify published practice change projects. PRISMA (Preferred ReportingItems for Systematic Reviews and Meta-analyses) guidelines were followed. Fifty articles met the inclusion criteria. Data were extracted; content analysis was conducted. The Quality Improvement Minimum Quality Criteria Set guided quality assessment.Results: Topics included infection control/prevention (n = 18), pain/palliative care (n = 13), psychosocial assessment (n = 11), and medication adherence (n = 8).Among the projects, Plan, Do, Study, Act (n = 8) and Lean Six Sigma (n = 6) frameworks were used most. Thirty-six projects identified guidelines that directed interventions. Multiple implementation strategies were reported in all articles with planning, education, and restructuring the most common. Reach, sustainability, and ability to be replicated were identified as quality gaps across projects. Conclusion: The EBP topics that emerged are consistent with the oncology nursing priorities, including facilitating integration of EBP into practice. The studies identified used national guidelines and implementation strategies to move evidence into practice. Heterogeneity in

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A novel prevention bundle to reduce incisional infections after radical cystectomy

Cited by 3 publications

References 26 publications

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Urinary diversions for benign and oncologic indications: what did we learn about short term complications in the last 24 months?

Association between radical cystectomy prophylactic antimicrobial regimen and postoperative infection

Translation of Evidence-Based Interventions Into Oncology Care Settings

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