Superficial surgical site infection after colorectal surgery: Targeting high-risk patients increases the efficacy of prevention bundles

• Published in: Turkish journal of colorectal disease Vol. 28; no. 1; pp. 9 - 17
• Main Authors: Rencüzoğulları, Ahmet, Trunzo, Joseph A, Vogel, Jon D, Khoshknabi, Dilara, Stocchi, Luca, Görgün, Emre
• Format: Journal Article
• Language: English; Turkish
• Published: Mersin Türk Kolon Ve Rektum Cerrahisi Derneği 01.03.2018; Galenos Publishing House
• Subjects: Colorectal surgery; high-risk patients; prevention bundle; Superficial surgical site infection; Surgical site infections; Tıp; İstanbul; önlem demeti; Yüzeyel cerrahi alan enfeksiyonları; kolorektal cerrahi; Superficial surgical site infection; colorectal surgery; prevention bundle; yüksek riskli hastalar; high-risk patients
• ISSN: 2536-4898; 2536-4901
• DOI: 10.4274/tjcd.82474

Aim: Applying prevention bundles to all patients to reduce surgical site infections (SSI) after colorectal surgery is expensive and has minimal success. The aim of this study was to identify factors associated with high-risk of superficial SSI and to assess the impact of prevention measures on high-risk patients. Method: Between January 2010 and February 2014, patients who underwent colorectal surgical procedures were separated into the pre-bundle period (January 2010-July 2012) and bundle period (August 2012-February 2014). Factors associated with superficial SSI risk were evaluated. Pre-bundle and bundle patients were categorized in deciles from low- to high-risk using a risk model. The impact of prospectively introduced protective measures was assessed in the bundle patients with multivariate modeling and frequency-matched analysis. Results: There were 2.535 pre-bundle patients who underwent ileocolic (19.1%), left-sided (46%), and pelvic (34.9%) procedures. Overall superficial SSI rate was 10.7%. Four patient-related factors and five procedure-related factors were found to be significantly associated with superficial SSI on unadjusted analysis. Comparison of pre-bundle patients on whom the risk model was built and the bundle patients used in the risk assessment showed significant decrease in superficial SSI rates (10.6% to 3.2%, p<0.001). Frequency matched analysis demonstrated a significant reduction in superficial SSI from pre-bundle to bundle patients (13.1 to 4.2%, p<0.001). Among the risk deciles in bundle patients, the reduction from the average predicted risk to the observed superficial SSI rate was most evident among the high-risk groups. Conclusion: Preventive strategies specifically aimed at patients with the highest risk for superficial SSI after colorectal surgery resulted in the highest reduction. Considering the variability of SSI rates, collaborative and targeted policies are critical to ensure efficacious and potentially cost-effective strategies.