Are Perioperative Bundles Associated With Reduced Postoperative Morbidity in Women Undergoing Benign Hysterectomy? Retrospective Cohort Analysis of 16,286 Cases in Michigan

Harris, John A.; Sammarco, Anne G.; Swenson, Carolyn W.; Uppal, Shitanshu; Kamdar, Neil; Campbell, D.A.; Evilsizer, Sarah; DeLancey, John O.L.; Morgan, Daniel M.

doi:10.1097/ogx.0000000000000437

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…The literature consistently shows that adherence rates are an ongoing struggle, and direct correlations have been shown between bundle compliance and outcomes. 16 In response to this regression, we reconvened our original large coalition of stakeholders and completed a process map to refocus our energy on SSI reduction. We were able to get back on track with better compliance and continued reduction in SSI rates, but were reminded of the need for ongoing vigilance and teamwork.…”

Section: Discussionmentioning

confidence: 99%

Surgical Site Infection Reduction Bundle: Implementation and Challenges at Ventura County Medical Center

Losh

Gough

Rutherford

et al. 2017

The American Surgeon

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Surgical Site Infections (SSIs) are a significant cause of morbidity and increased cost in the postoperative patient occurring in 2–5 per cent of those undergoing inpatient surgery. Ventura County Medical Center (VCMC) initiated an SSI reduction bundle in 2013, to try to reduce the incidence of SSI. The bundle is a series of best practices including preoperative, perioperative, intraoperative, and postoperative components, as well as items focused on the staff and electronic medical record. VCMC started with a 6.1 per cent SSI rate in 2013. A consistent reduction in SSI rate followed each quarter after that for a rate of less than 2.0 per cent in early 2016. The most critical aspect of this process was the necessary collaboration between disparate departments and the ongoing investment of the staff to this challenging process; the people at the heart of the collaborative process were the key to its success.

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Section: Discussionmentioning

confidence: 99%

Surgical Site Infection Reduction Bundle: Implementation and Challenges at Ventura County Medical Center

Losh

Gough

Rutherford

et al. 2017

The American Surgeon

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“…These included a minimally invasive approach, appropriate preoperative antibiotics, operative duration of less than 2 hours, and absence of intraoperative hemostatic agent use. Of all cohorts missing Biologic Hemostatic Agents in Obstetrics and Gynecology DOI: http://dx.doi.org/10.5772/intechopen.96969 only one of the four criteria, there was an association with a greater risk of postoperative complications in hyterectomies for benign indications in which hemostatic agents were used [44].…”

Section: Hysterectomymentioning

confidence: 99%

Biologic Hemostatic Agents in Obstetrics and Gynecology

Patriarco¹,

Shenoy²,

Taylor³

2021

Contemporary Applications of Biologic Hemostatic Agents Across Surgical Specialties - Volume 2 [Working Title]

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In Obstetrics and Gynecology, the practice of biologic hemostatic agents in the field are generally used to augment the basic tenets of hemostasis to decrease the morbidity and mortality of such procedures. These hemostatic agents work along with the body’s physiology to rapidly aid in platelet plug formation, activation of the clotting cascade, the creation of fibrin, and to form a stable clot. The four main sub-categories of hemostatic agents include mechanical, biological, flowable, and fibrin sealants. Mechanical agents act as scaffolding for platelet aggregation to form a platelet plug. Biological agents activate clotting factors in the coagulation cascade to aid in hemostasis. Flowable agents combine biologic with mechanical agents to stabilize clot formation while also providing mechanical tamponade. Fibrin sealants combine high levels of fibrin and thrombin that when combined, form a fibrin clot at an accelerated speed. Hemostatic agents in obstetrics are often used in the setting of postpartum hemorrhage, cesarean delivery and postpartum hysterectomy to decrease the rate of morbidity most commonly seen with abnormal placentation and uterine atony. With gynecologic surgery, hemostatic agents are more commonly used then in obstetrics. They aid in hemostasis with common gynecologic procedures including hysterectomies, ovarian cystectomies, myomectomies, endometriosis cases, incontinence procedures and malignant debulking procedures. Also, with the increase in minimally invasive surgical techniques, topical hemostasis can aid in fewer transfusions, improved visualization in the surgical field decreased operative time and reduction in the risk of conversion to laparotomy.

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“…Bundling three to five evidence-based strategies, 18 such as preoperative antibiotics, frequent glove changing and wound irrigation, has reduced post-surgical infections in other specialties such as urology 19 and gynecology. 20 We performed a systematic review and meta-analysis to identify any interventions, including but not limited to antibiotics, that successfully prevent UTI and/or bacteriuria, compared with no intervention, in women undergoing MUS surgery with or without concomitant pelvic reconstructive procedures for prolapse.…”

Section: Introductionmentioning

confidence: 99%

Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta‐analysis

Sanaee

Hutcheon

Larouche

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Synthetic midurethral slings are the most common procedures currently performed for stress urinary incontinence in women. Infection is a frequent complication of urogynecologic surgery. We performed a systematic review and meta‐analysis to identify interventions that successfully prevent infections, including urinary tract infection (UTI) and/or bacteriuria, compared with no intervention, in women undergoing midurethral sling surgery with or without concomitant pelvic reconstructive procedures for prolapse. Material and methods The primary outcome was the development of any infection post‐midurethral sling placement in women. MEDLINE, Embase, CINAHL and the Cochrane Library were searched for comparative studies from inception to July 2017, with no language restrictions. We used search terms related to midurethral sling, infections and infection‐reduction interventions. Two independent reviewers abstracted data and assessed study quality. Pooled effect size estimates were calculated. We conducted meta‐analysis of eligible studies. A protocol for this review has been registered and can be accessed online (http://hdl.handle.net/2429/64731). Results We identified seven eligible studies of infection risk‐reducing interventions; all focused on UTIs. Only one study assessed preoperative antibiotics with midurethral sling alone and was halted early because of low UTI rates. All other studies (three randomized control trials and three observational studies) examined whether postoperative antibiotics decrease UTI/bacteriuria rates after midurethral sling with or without reconstructive procedures for pelvic organ prolapse and using bladder catheterization postoperatively. Due to considerable clinical heterogeneity, we only combined four studies for meta‐analysis. Postoperative oral prophylactic nitrofurantoin showed no significant benefit in reducing UTI/bacteriuria in women post‐midurethral sling with or without concomitant reconstructive pelvic surgery and the need for bladder catheterization, when compared with the reference group (pooled relative risk 0.73, 95% confidence interval [CI] 0.42‐1.25). Conclusions Based on the best available evidence, postoperative oral nitrofurantoin is not effective at reducing UTI/bacteriuria rates in catheterized women after midurethral sling with or without concomitant pelvic reconstructive surgery for prolapse. For midurethral sling alone, preoperative antibiotic prophylaxis may not be needed for UTI prevention.

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Are Perioperative Bundles Associated With Reduced Postoperative Morbidity in Women Undergoing Benign Hysterectomy? Retrospective Cohort Analysis of 16,286 Cases in Michigan

Abstract: Background-Healthcare teams that frequently follow a bundle of evidence-based processes provide care with lower rates of morbidity. Few process bundles to improve surgical outcomes in hysterectomy have been identified.

Cited by 3 publications

References 20 publications

Surgical Site Infection Reduction Bundle: Implementation and Challenges at Ventura County Medical Center

Surgical Site Infection Reduction Bundle: Implementation and Challenges at Ventura County Medical Center

Biologic Hemostatic Agents in Obstetrics and Gynecology

Urinary tract infection prevention after midurethral slings in pelvic floor reconstructive surgery: A systematic review and meta‐analysis

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