Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study

Identifier:  imarina:9423646

Handle: https://hdl.handle.net/20.500.11797/imarina9423646

Authors:  Flores-Yelamos M; Gomila-Grange A; Badia JM; Almendral A; Vázquez A; Parés D; Pascual M; Limón E; Pujol M; Juvany M; Fraccalvieri D; Abad-Torrent A; Solís-Peña A; Puig-Asensio M; López L; Piriz M; Hernández M; Castellana D; González EM; Pardo GG; Villaró FF; Fatsini JR; Spaneda MFD; Galí MC; Pérez-Hita AO; Martín L; Lerida A; Biondo S; Martínez EJ; Galindo NS; Ausàs IC; Ferrer C; Salas L; Vidal RP; Rubio DM; de la Red IG; Castillo MAI; Palau i Gil E; Martínez JA; Navarro MBT; López M; Porta C; Amat AS; Escudero GV; de la Fuente Redondo JC; Espés MR; Fidalgo AM; Almazán LE; Raya MO; Moya MCÁ; Diaz-Brito V; Palafox LG; Gómez YA; Codina AB; Ricard CA; López CH; Lerma-Chippirraz E; López DM; Blancas D; Rubio EM; Ferrer i Aguilera R; Iftimie S; Castro-Salomó A; Enguídanos RL; Serra MCS; Ros NB; Solchaga VP; Garcia LL; Ribas AB; Luque JP; Moise AL; Palomares MCF; Sopeña SB; Huertas ES; Estada SB; Leris JMT; Ruiz ER; Brugués M; Aced SO; Esteve MC; Vargas-Machuca FJ; de Gracia García Ramírez M; Bellés AMC; Díez EV; Morón MM; Sáez MM; Farguell J; Saballs M; Franco MV; Garcia LI; Marrugat MG; Conde AC

Abstract:
Background: There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level. Methods: A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after the sequential implementation of two preventive bundle protocols. Secondary outcomes were to determine compliance with individual measures and to establish their effectiveness, duration of stay, microbiology and 30-day mortality rate. Results: A total of 32 205 patients were included. A 50% reduction in surgical site infection was achieved after the implementation of two sequential sets of bundles: from 18.16% in the Baseline group to 10.03% with Bundle-1 and 8.19% with Bundle-2. Bundle-2 reduced superficial-surgical site infection (OR 0.74 (95% c.i. 0.58 to 0.95); P = 0.018) and deep-surgical site infection (OR 0.66 (95% c.i. 0.46 to 0.93); P = 0.018) but not organ/space-surgical site infection (OR 0.88 (95% c.i. 0.74 to 1.06); P = 0.172). Compliance increased after the addition of four measures to Bundle-2. In the multivariable analysis, for organ/space-surgical site infection, laparoscopy, oral antibiotic prophylaxis and mechanical bowel preparation were protective factors in colonic procedures, while no protective factors were found in rectal surgery. Duration of stay fell significantly over time, from 7 in the Baseline group to 6 and 5 days for Bundle-1 and Bundle-2 respectively (P < 0.001). The mortality rate fell from 1.4% in the Baseline group to 0.59% and 0.6% for Bundle-1 and Bundle-2 respectively (P < 0.001). There was an increase in Gram-positive bacteria and yeast isolation, and reduction in Gram-negative bacteria and anaerobes in organ/space-surgical site infection. Conclusions: The addition of measures to create a final 10-measure protocol had a cumulative protective effect on reducing surgical site infection. However, organ/space-surgical site infection did not benefit from the addition. No protective measures were found for organ/space-surgical site infection in rectal surgery. Compliance with preventive measures increased from Bundle-1 to Bundle-2.