Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery

“…The Dartmouth colorectal group implemented a similar bundle and, in a NSQIP series of 119 patients, were able to achieve 1st quartile (exemplary status) with an observed SSI rate of 3.4% vs. a predicted observed rate of 6.1% and expected rate of 9.7% (odds ratio, 0.59, 95% confidence interval 0.34–1.03) (Holubar 2016). Similarly, a study from the Duke colorectal group reported on the sequential effect of first ERP and then their bundle on their SSI rates (Keenan et al 2015). They found that ERP implementation was associated with a reduced LOS (8.3 vs. 6.6 days, p  < 0.01), but a reduction in SSI was not observed until after implementation of the bundle, when their SSI rate decreased from 16.1 to 6.3% ( p  < 0.01), and their sepsis rate fell from 11.2 to 1.8% ( p  < 0.01).…”

Surgical Site Infection: The Clinical and Economic Impact

“…24 Enhanced recovery pathways and bundled SSI reduction protocols have become common in colorectal surgery groups in an attempt to improve postoperative outcomes. [40][41][42][43] During this time, minimally invasive surgical technique has demonstrated substantial improvements in SSI rates compared with open procedures with reductions as high as 60% with use of minimally invasive surgery compared with open surgical techniques. 44,45 Bundle protocols are proposed as a cost-effective mechanism for further reduction in SSI when implemented in aggregate.…”

Current management of small bowel obstruction in the UK: results from the National Audit of Small Bowel Obstruction clinical practice survey

“…Development of protocols is not in itself sufficient to reduce variation; adherence to protocols also requires perseverance and monitoring, and this is more difficult to achieve in emergency than elective situations . There are undoubtedly potential cost savings in adherence to protocol‐driven management pathways . Our study suggests that dispensing with the additional cost of a plain abdominal radiograph is one potential cost saving, given the high proportion of consultants who prioritize abdominal CT in managing SBO.…”