Coloration of Calpoprotectin and Prealbumin Serum Levels in Patients with Colorectal Cancer

Abstract

INTRODUCTION: Surgical site infections (SSIs) represent significant morbidity and financial implications after 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 were divided into pre-hospital and pre-, intra-, and postoperative measures. These included standardized mechanical and antibiotic bowel preparation, skin cleansing, alcohol-based skin preparation, maintenance of normothermia, antimicrobial prophylaxis, optimal tissue oxygenation, glucose control, a clean standardized fascial closure process, and negative pressure wound therapy. Specific enhanced preoperative patient education was provided. Consecutive patients who underwent a colorectal procedure between January 2015 and January 2016 were included. SSIs were recorded and subdivided by wound class. RESULTS: Implementation of the colon bundle led to a significant decrease in SSIs 7% (11/198) vs 15% (26/175) (p <0.05) when compared to the year prior. 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%). CONCLUSIONS: We demonstrate 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. This approach to incorporating an advanced surgery bundle for colon and rectal procedures can provide an effective strategy to reduce SSIs.