Effect of a Surgical Care Bundle on the Incidence of Surgical Site Infection in Colorectal Surgery: A Quasi-Experimental Intervention

Abstract

Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant. (REV INVEST CLIN. [AHEAD OF PRINT]

Morbidity and Mortality of Neutropenic Patients in Visceral Surgery: A Narrative Review

“…It is plausible that immunological disturbances might be able to aggravate the pathogenetic process of SSI by opening the door for microbes, which are harmful for immunocompromised patients. Zarain-Obrador et al evaluated data of 1727 patients, who underwent colorectal surgery given their risk of SSI [ 38 ]. Sixteen percent of patients had emergency surgery.…”

Infecções de sítio cirúrgico: reabordagem cirúrgica e infecção em cirurgias limpas e potencialmente contaminada

“…[15][16] Neste trabalho, 20% dos pacientes foram submetidos a cirurgia de urgência, valor próximo ao encontrado em um estudo realizado, que avaliou os fatores de risco para infecção em pacientes e encontrou um percentual de 16,3% de cirurgias consideradas de urgência. 17 Existem fatores que aumentam a chance de um paciente cirúrgico desenvolver uma infecção. Entre eles encontram-se a idade, a condição clínica do paciente, o preparo pré-operatório, o tempo de cirurgia e a classificação quanto ao potencial de contaminação do sítio cirúrgico em relação à presença de microrganismos.…”

“…1 As cirurgias potencialmente contaminadas são realizadas em tecidos colonizados por flora microbiana sem processos de infecção e inflamação, como também em cirurgias com falhas técnicas discretas intraoperatórias. 17 As cirurgias limpas e potencialmente contaminadas apresentam baixo percentual de risco de desenvolvimento de infecção, 7 sendo assim a presença de ISC implica a reflexão quanto à necessidade de identificação dos fatores relacionados a seu desenvolvimento. É necessário levar em consideração todos os aspectos que podem influenciar a maior ocorrência de infecção, como fato de o hospital ser uma instituição de ensino o que contribui para índices maiores de eventos adversos, entre eles as ISCs conforme resultado encontrado em estudo que avaliou esse perfil de hospitais.…”

Evaluation of Absolute Neutrophil Count in the Perioperative Setting of Sarcoma Resection

“…Neutropenia is defned as ANC below 1500 cells per microliter (μL) and is associated with increased susceptibility to infections, diminished infammatory response, and higher mortality [8,9]. Neutropenic patients undergoing abdominal surgery have demonstrated higher rates of postoperative complications, surgical site infections (SSI), and morbidity [10][11][12]. Zarain-Obrador et al [12] reported preoperative neutropenia as an independent predictor of SSI in 1,727 colorectal surgeries.…”