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
DOI/URL:
Notes: Source: Scopus
Altmetric Score
MSK Authors
  1. Mithat Gonen
    716 Gonen
  2. Peter Allen
    442 Allen
  3. William R Jarnagin
    596 Jarnagin
  4. T Peter Kingham
    293 Kingham
  5. Yuting Chou
    7 Chou
  6. Kenneth Seier
    23 Seier
  7. Jeffrey Adam Drebin
    13 Drebin