TY - JOUR
T1 - Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
AU - Flores-Yelamos, Miriam
AU - Gomila-Grange, Aina
AU - Badia, Josep M
AU - Almendral, Alexander
AU - Vázquez, Ana
AU - Parés, David
AU - Pascual, Marta
AU - Limón, Enric
AU - Pujol, Miquel
AU - Juvany, Montserrat
AU - Fraccalvieri, Domenico
AU - Abad-Torrent, Ana
AU - Solís-Peña, Alejandro
AU - Puig-Asensio, Mireia
AU - López, Lucrecia
AU - Piriz, Marta
AU - Hernández, Mercè
AU - Castellana, Dolors
AU - González, Elisa Montiu
AU - Pardo, Graciano García
AU - Villaró, Francesc Feliu
AU - Fatsini, Josep Rebull
AU - Spaneda, Marie France Domènech
AU - Galí, Marta Conde
AU - Pérez-Hita, Anna Oller
AU - Martín, Lydia
AU - Lerida, Ana
AU - Biondo, Sebastiano
AU - Martínez, Emilio Jiménez
AU - Galindo, Nieves Sopena
AU - Ausàs, Ignasi Camps
AU - Ferrer, Carmen
AU - Salas, Luis
AU - Vidal, Rafael Pérez
AU - Rubio, Dolors Mas
AU - Red, Irene García de la
AU - Castillo, Mª Angels Iruela
AU - Gil, Eva Palau i
AU - Martínez, José Antonio
AU - Navarro, M Blanca Torralbo
AU - López, Maria
AU - Porta, Carol
AU - Amat, Alex Smithson
AU - Escudero, Guillen Vidal
AU - Redondo, José Carlos de la Fuente
AU - Espés, Montse Rovira
AU - Fidalgo, Arantxa Mera
AU - Almazán, Luis Escudero
AU - Raya, Monserrat Ortega
AU - Moya, Mª Carmen Álvarez
AU - Diaz-Brito, Vicens
AU - Palafox, Laura Grau
AU - Gómez, Yésika Angulo
AU - Codina, Anna Besolí
AU - Ricard, Carme Autet
AU - López, Carlota Hidalgo
AU - Lerma-Chippirraz, Elisabeth
AU - López, Demelza Maldonado
AU - Blancas, David
AU - Rubio, Esther Moreno
AU - Aguilera, Roser Ferrer i
AU - Iftimie, Simona
AU - Castro-Salomó, Antoni
AU - Enguídanos, Rosa Laplace
AU - Serra, Maria Carmen Sabidó
AU - Ros, Núria Bosch
AU - Solchaga, Virginia Pomar
AU - Garcia, Laura Lázaro
AU - Ribas, Angeles Boleko
AU - Luque, Jordi Palacín
AU - Moise, Alexandra Lucía
AU - Palomares, Mª Carmen Fernández
AU - Sopeña, Santiago Barba
AU - Huertas, Eduardo Sáez
AU - Estada, Sara Burges
AU - Leris, Josep María Tricas
AU - Ruiz, Eva Redon
AU - Brugués, Montse
AU - Aced, Susana Otero
AU - Esteve, Maria Cuscó
AU - Vargas-Machuca, Francisco José
AU - Ramírez, Mª de Gracia García
AU - Bellés, Ana Maria Ciscar
AU - Díez, Elena Vidal
AU - Morón, Mariló Marimón
AU - Sáez, Marisol Martínez
AU - Farguell, Josep
AU - Saballs, Mireia
AU - Franco, Montserrat Vaqué
AU - Garcia, Leonor Invernón
AU - Enguídanos, Rosa Laplace
AU - Marrugat, Meritxell Guillemat
AU - Conde, Ana Coloma
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - 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.
AB - 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.
KW - Aged
KW - Antibiotic Prophylaxis/methods
KW - Cohort Studies
KW - Colon/surgery
KW - Colorectal Surgery/adverse effects
KW - Elective Surgical Procedures/adverse effects
KW - Female
KW - Humans
KW - Length of Stay
KW - Male
KW - Middle Aged
KW - Patient Care Bundles
KW - Rectum/surgery
KW - Surgical Wound Infection/prevention & control
UR - http://www.scopus.com/inward/record.url?scp=85200828427&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/270001d7-45c9-3bff-ac9e-457db0bf1762/
U2 - 10.1093/bjsopen/zrae080
DO - 10.1093/bjsopen/zrae080
M3 - Article
C2 - 39107075
SN - 2474-9842
VL - 8
JO - BJS open
JF - BJS open
IS - 4
M1 - zrae080
ER -