Perioperative bundle to reduce surgical site infection after pancreaticoduodenectomy: A prospective cohort study Journal Article

   


Authors: Lawrence, S. A.; McIntyre, C. A.; Pulvirenti, A.; Seier, K.; Chou, Y.; Gonen, M.; Balachandran, V. P.; Kingham, T. P.; D'Angelica, M. I.; Drebin, J. A.; Jarnagin, W. R.; Allen, P. J.
Article Title: Perioperative bundle to reduce surgical site infection after pancreaticoduodenectomy: A prospective cohort study
Abstract: Background: Pancreaticoduodenectomy is historically associated with incisional surgical site infection (iSSI) rates between 15% and 20%. Prospective studies have been mixed with respect to the benefit of individual interventions directed at decreasing iSSI. We hypothesized that the application of a perioperative bundle during pancreaticoduodenectomy would decrease the rate of iSSIs significantly. Methods: An initial cohort of 150 consecutive post-pancreaticoduodenectomy patients were assessed within 2 to 4 weeks of operation to determine baseline iSSI rates. The CDC definition of iSSI was used. A 4-part perioperative bundle was then instituted for the second cohort of 150 patients. This bundle consisted of a double-ring wound protector, gown/glove and drape change before fascial closure, irrigation of the wound with bacitracin solution, and a negative-pressure wound dressing that was left in place until postoperative day 7 or day of discharge. Three-hundred patients provided 80% power to detect a 50% risk reduction in iSSIs. Results: Cohorts 1 and 2 were similar with respect to age (68 vs 69 years; p = 0.918), sex (male, 51% vs 55%; p = 0.644), BMI (26 vs 26 kg/m 2 ; p = 0.928), use of neoadjuvant therapy (21% vs 17%; p = 0.377), median operative time (222 vs 215 minutes; p = 0.366), and presence of a preoperative stent (53% vs 41%; p = 0.064). The iSSI rate was 22.3% in the initial cohort. This rate was higher than both our institutional database (13%) and NSQIP reporting (11%). Within the second cohort, the iSSI rate decreased significantly to 10.7% (n = 16; p = 0.012). All 4 components of the bundle were used in 91% of cohort 2 patients. Conclusions: In this cohort study of 300 consecutive patients who underwent pancreaticoduodenectomy, the implementation of a 4-part bundle decreased iSSI rate from 22% to 11%. © 2019 American College of Surgeons
Keywords: adult; aged; antibiotic agent; major clinical study; neoadjuvant therapy; prospective study; pancreaticoduodenectomy; cohort analysis; body mass; operation duration; surgical infection; perioperative period; risk reduction; wound infection; human; male; female; priority journal; article; bacitracin; perioperative bundle
Journal Title: Journal of the American College of Surgeons
Volume: 228
Issue: 4
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2019-04-01
Start Page: 595
End Page: 601
Language: English
DOI: 10.1016/j.jamcollsurg.2018.12.018
PUBMED: 30630087
PROVIDER: scopus
PMCID: PMC8427889
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85060768359&doi=10.1016%2fj.jamcollsurg.2018.12.018&partnerID=40&md5=9a9495bab00d132d18e781c4507a3ecf
Notes: Source: Scopus
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MSK Authors
  1. Mithat Gonen
    1028 Gonen
  2. Peter Allen
    501 Allen
  3. William R Jarnagin
    903 Jarnagin
  4. Michael D'Angelica
    777 D'Angelica
  5. T Peter Kingham
    609 Kingham
  6. Vinod P Balachandran
    251 Balachandran
  7. Yuting Chou
    11 Chou
  8. Kenneth Seier
    104 Seier
  9. Sharon Anita Lawrence
    15 Lawrence
  10. Jeffrey Adam Drebin
    165 Drebin
  11. Alessandra Pulvirenti
    30 Pulvirenti
  12. Caitlin Anne McIntyre
    39 McIntyre
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