Colorectal surgery and surgical site infection: is a change of attitude necessary?

Elía-Guedea, Manuela; Laspra, Elena Córdoba-Díaz de; Echazarreta-Gallego, Estíbaliz; Valero-Lazaro, María Isabel; Ramírez-Rodríguez, José Manuel; Aguilella-Diago, Vicente

doi:10.1007/s00384-017-2801-0

Cited by 16 publications

(15 citation statements)

References 18 publications

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“…Because of the existence of numerous microbes in the rectum and colon, the SSI incidence of colorectal surgery is usually higher than those observed in other types of surgeries [4,5]. Little multicenter surveillance focusing on SSI after colorectal surgery has been carried out in China.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

et al. 2020

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Purposes Surgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors. Methods Two multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery. Results In total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group. Conclusion This study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.

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Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

et al. 2020

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“…The risk of bias was low in 5 studies (12%), medium in 14 studies (35%), high in 17 studies (43%), and indeterminate in 4 studies (10%) ( Table 1). The average Downs and Black individual study bias assessment score was 20.82 (range, [15][16][17][18][19][20][21][22][23][24][25][26]. Of the 36 studies that provided enough raw data to allow power calculations, 18 (50%) were powered at <80%.…”

Section: Study Quality and Bias Assessmentmentioning

confidence: 99%

“…(2) normothermia maintenance in 32 studies (80%); (3) perioperative glucose control in 22 studies (55%); (4) appropriate hair removal in 20 studies (50%); (5) mechanical and oral bowel preparation in 18 studies (45%); (6) preoperative bathing with chlorhexidine in 16 studies (40%); (7) standardized postoperative dressing removal and wound care in 16 studies (40%); (8) wound closure protocol including glove with or without gown change and separate instrument tray in 15 studies (38%); (9) use of wound protectors in 11 studies (28%); (10) use of supplemental oxygen postoperatively in 7 studies (18%); (11) cutaneous antisepsis with a solution containing chlorhexidine gluconate and isopropyl alcohol in 6 studies (15%); (12) preoperative smoking cessation in 4 studies (10%); (13) wearing appropriate surgical attire, restricted to the operating room (OR) in 2 studies (5%). Other interventions included minimizing OR traffic, 19,20,22,46,51 peritoneal lavage with antibiotics, 14,43 wound irrigation with antibiotic solution 15,26 or with saline before closure, 16,23,29,31,40 postoperative daily chlorhexidine showers, 18,21,32 and daily wound cleaning with chlorhexidine. 32,46,51 Adherence to colorectal SSI prevention bundles Adherence to colorectal SSI prevention bundles was reported in 28 studies (70%).…”

Section: Composition Of Colorectal Infection Prevention Bundlesmentioning

confidence: 99%

Colorectal bundles for surgical site infection prevention: A systematic review and meta-analysis

Pop-Vicas

Abad

Baubie

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:In colorectal surgery, the composition of the most effective bundle for prevention of surgical site infections (SSI) remains uncertain. We performed a meta-analysis to identify bundle interventions most associated with SSI reduction.Methods:We systematically reviewed 4 databases for studies that assessed bundles with ≥3 elements recommended by clinical practice guidelines for adult colorectal surgery. The main outcome was 30-day postoperative SSI rate (overall, superficial, deep, and/or organ-space).Results:We included 40 studies in the qualitative review, and 35 studies (54,221 patients) in the quantitative review. Only 3 studies were randomized controlled trials. On meta-analyses, bundles were associated with overall SSI reductions of 44% (RR, 0.57; 95% CI, 0.48–0.65); superficial SSI reductions of 44% (RR, 0.56; 95% CI, 0.42–0.75); deep SSI reductions of 33% (RR, 0.67; 95% CI, 0.46–0.98); and organ-space SSI reductions of 37% (RR, 0.63; 95% CI, 0.50–0.81). Bundle composition was heterogeneous. In our meta-regression analysis, bundles containing ≥11 elements, consisting of both standard of care and new interventions, demonstrated the greatest SSI reduction. Separate instrument trays, gloves with and without gown change for wound closure, and standardized postoperative dressing change at 48 hours correlated with the highest reductions in superficial SSIs. Mechanical bowel preparation combined with oral antibiotics, and preoperative chlorhexidine showers correlated with highest organ-space SSI reductions.Conclusions:Preventive bundles emphasizing guideline-recommended elements from both standard of care as well as new interventions were most effective for SSI reduction following colorectal surgery. High clinical-bundle heterogeneity and low quality for most observational studies significantly limit our conclusion.

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“…The main characteristics of all 40 included studies are presented in Table 2. Twenty-five studies were performed in the US [36, 37, 39, 45-52, 55, 56, 58-60, 62, 63, 65, 67, 69-73], two each in Australia [34,54], Canada [41,42], the Netherlands [38,44], Spain [40,64], and the UK [35,66], and one each in Germany [68], Saudi Arabia [53], Singapore [57], Switzerland [61], and Qatar [43]. Thirty-six studies were single-center studies, and four studies were performed in more than one hospital [50,65,66,69].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review

Tomsic

Heinze

Chaberny

et al. 2020

BMC Health Serv Res

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Background: Surgical site infections (SSIs) are highly prevalent in abdominal surgery despite evidence-based prevention measures. Since guidelines are not self-implementing and SSI-preventive compliance is often insufficient, implementation interventions have been developed to promote compliance. This systematic review aims to identify implementation interventions used in abdominal surgery to prevent SSIs and determine associations with SSI reductions. Methods: Literature was searched in April 2018 (Medline/PubMed and Web of Science Core Collection). Implementation interventions were classified using the implementation subcategories of the EPOC Taxonomy (Cochrane Review Group Effective Practice and Organisation of Care, EPOC). Additionally, an effectiveness analysis was conducted on the association between the number of implementation interventions, specific compositions thereof, and absolute and relative SSI risk reductions. Results: Forty studies were included. Implementation interventions used most frequently ("top five") were audit and feedback (80% of studies), organizational culture (70%), monitoring the performance of healthcare delivery (65%), reminders (53%), and educational meetings (45%). Twenty-nine studies (72.5%) used a multimodal strategy (≥3 interventions). An effectiveness analysis revealed significant absolute and relative SSI risk reductions. E.g., numerically, the largest absolute risk reduction of 10.8% pertained to thirteen studies using 3-5 interventions (p < .001); however, this was from a higher baseline rate than those with fewer or more interventions. The largest relative risk reduction was 52.4% for studies employing the top five interventions, compared to 43.1% for those not including these. Furthermore, neither the differences in risk reduction between studies with different numbers of implementation interventions (bundle size) nor between studies including the top five interventions (vs. not) were significant.

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Colorectal surgery and surgical site infection: is a change of attitude necessary?

Abstract: The preventive set of measures applied in colorectal surgery led to a significant reduction of the SSI and of the length of hospital stay.

Cited by 16 publications

References 18 publications

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

Colorectal bundles for surgical site infection prevention: A systematic review and meta-analysis

Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review

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