A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection Journal Article


Authors: Tufts, L. S.; Jarnagin, E. D.; Flynn, J. R.; Gonen, M.; Guillem, J. G.; Paty, P. B.; Nash, G. M.; Smith, J. J.; Wei, I. H.; Pappou, E.; D'Angelica, M. I.; Allen, P. J.; Kingham, T. P.; Balachandran, V. P.; Drebin, J. A.; Garcia-Aguilar, J.; Jarnagin, W. R.; Weiser, M. R.
Article Title: A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection
Abstract: Background: Surgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs, and patients undergoing simultaneous colorectal/liver resections are at an especially high SSI risk. Methods: Data were collected on all patients undergoing synchronous colorectal/liver resection from 2011 to 2016 (n = 424). The intervention, implemented in 2013, included 13 multidisciplinary perioperative components. The primary endpoints were superficial/deep and organ space SSIs. Secondary endpoints were hospital length of stay (LOS) and 30-day readmission rate. To control for changes in SSI rates independent of the intervention, interrupted time series analysis was conducted. Results: Overall, superficial/deep, and organ space SSIs decreased by 60.5% (p < 0.001), 80.6% (p < 0.001), and 47.6% (p = 0.008), respectively. In the pre-intervention cohort (n = 231), there were 79 (34.2%), 31 (13.4%), and 48 (20.8%) total, superficial/deep, and organs space SSIs, respectively. In the post-intervention cohort (n = 193), there were 26 (13.5%), 5 (2.6%), and 21 (10.9%) total, superficial/deep, and organs space SSIs, respectively. Median LOS decreased from 9 to 8 days (p < 0.001). Readmission rates did not change (p = 0.6). Interrupted time series analysis found no significant trends in SSI rate within the pre-intervention (p = 0.35) and post-intervention (p = 0.55) periods. Conclusion: In combined colorectal/liver resection patients, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSIs, with the greatest impact on superficial/deep SSI, and modest reduction in LOS. The absence of trends within each time period indicated that the intervention was likely responsible for SSI reduction. Future efforts should target further reduction in organ space SSI. © 2018
Keywords: adult; aged; major clinical study; laparoscopic surgery; smoking; retrospective study; length of stay; reoperation; surgical infection; colon resection; intestine preparation; liver resection; sepsis; intestine resection; perioperative period; hospital readmission; chlorhexidine; time series analysis; metronidazole; wound closure; percutaneous drainage; rectum resection; neomycin; hemoglobin a1c; ostomy; charlson comorbidity index; human; male; female; article; cefotetan; high volume hospital
Journal Title: HPB
Volume: 21
Issue: 2
ISSN: 1365-182X
Publisher: Elsevier Science, Inc.  
Date Published: 2019-02-01
Start Page: 181
End Page: 186
Language: English
DOI: 10.1016/j.hpb.2018.07.001
PUBMED: 30077525
PROVIDER: scopus
PMCID: PMC6358518
DOI/URL:
Notes: Article -- Export Date: 1 April 2019 -- Source: Scopus
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MSK Authors
  1. Philip B Paty
    373 Paty
  2. Mithat Gonen
    716 Gonen
  3. Jose Guillem
    373 Guillem
  4. Martin R Weiser
    346 Weiser
  5. Peter Allen
    442 Allen
  6. William R Jarnagin
    596 Jarnagin
  7. T Peter Kingham
    293 Kingham
  8. Garrett Nash
    136 Nash
  9. Jesse Joshua Smith
    49 Smith
  10. Jeffrey Adam Drebin
    13 Drebin
  11. Emmanouil Pappou
    6 Pappou
  12. Jessica Flynn
    10 Flynn
  13. Lauren Tufts
    2 Tufts
  14. Iris Hsin - chu Wei
    7 Wei