Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

Abstract

Objective Surgical site infections (SSIs) can lead to substantial morbidity, prolonged hospitalization, increased costs, and death in patients undergoing colorectal procedures. We sought to investigate the effect of using an SSI reduction bundle on the rate of SSIs in gynecologic cancer patients undergoing colon surgery. Methods We identified all gynecologic cancer patients who underwent colon resection at our institution from 2014–2016, during which time a service-wide SSI reduction bundle was introduced. The intervention included preoperative oral antibiotics with optional mechanical bowel preparation, skin preparation with antibacterial solution, and the use of a separate surgical closing tray. SSI rates were assessed within 30 days post-surgery. Results Of 233 identified patients, 115 had undergone colon surgery prior to (PRE) and 118 after (POST) the implementation of the intervention. A low anterior resection was the most common colon surgery in both cohorts. The incidence of SSI within 30 days of surgery was 43/115 (37%) in the PRE and 14/118 (12%) in the POST cohorts (p≤0.001). Wound dehiscence was noted in 30/115 (26%) and 2/118 (2%) patients, respectively (p≤0.001). In patients whose operation took longer than 360 minutes, 30-day SSI rates were 37% (28/76) and 12% (8/67), respectively (p≤0.001). In patients with an estimated blood loss >500 cc, SSI rates were 44% (27/62) and 15% (10/67), respectively (p≤0.001). Conclusions The implementation of an SSI reduction bundle was associated with a significant reduction in 30-day SSIs in these patients. The intervention remained effective in patients undergoing longer operations and in those with increased blood loss.

Povidone-iodine vs chlorhexidine alcohol for skin preparation in malignant and premalignant gynaecologic diseases: A randomized controlled study

“…SSI reduction was greatest in patients who underwent colon resection, from 33% to 7% (OR 0.14, 95% CI 0.037-0.53, p = 0.001). In a study of patients with gynaecologic cancer undergoing colon surgery, the incidence of SSI was reduced from 37% to 12% with bundles using 4% chlorhexidine antibacterial solution [32]. In the present study, there was no significant difference between povidone-iodine and chlorhexidine solutions in general.…”

Surgical Site Infection Wound Bundles Should Become Routine in Colorectal Surgery: A Meta-Analysis

“…Despite the heterogeneity there was significant reduction in the risk of SSIs by 46% (RR=0.54; 95% CI, 0.46-0.64; p<.00001, I 2 =73%) (Figure 2). 22 of the 25 studies had a statistically significant decrease in overall SSI rates following bundle implementation [16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Two studies showed no effect [21,40] and Anthony, et al 2011 [15] reported a statistically significant increase in SSI after bundle implementation.…”

Enhanced recovery pathways and patient‐reported outcome measures in gynaecological oncology

“…As a result of implementing enhanced recovery pathways with multimodal analgesia, multiple single‐centre studies have shown significant reductions of peri‐operative opioid requirements and lower reported pain scores in gynaecologic patients who underwent laparotomy when compared with historical controls who had the same procedure without a pathway in place [28–30]. Studies have also reported statistically significant reductions in 30‐day surgical site infection risk among patients undergoing these procedures and have reported success with specific interventions including: setting patient and caregiver expectations; early patient education; pre‐operative antimicrobial washing; and timely administration of prophylactic antibiotics before surgery [31–33].…”