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

Tufts, Lauren; Jarnagin, Emma D.; Flynn, Jessica; Gönen, Mithat; Guillem, José G.; Paty, Philip B.; Nash, Garrett M.; Smith, Joshua J.; Wei, Iris; Pappou, Emmanouil P.; D’Angelica, Michael I.; Allen, Peter J.; Kingham, T. Peter; Balachandran, Vinod P.; Drebin, Jeffrey A.; García-Aguilar, Julio; Jarnagin, William R.; Weiser, Martin R.

doi:10.1016/j.hpb.2018.07.001

Cited by 11 publications

(15 citation statements)

References 34 publications

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“…Three studies explored this variable 22,23,25 . Keenan et al 22 reported a correlation between superficial SSI occurrence and an increase in LOS (7.9 vs 4.6 days; P < .001).…”

Section: Resultsmentioning

confidence: 99%

“…Figure 3 outlines the results of the meta-analysis of 14 studies using an SSI prevention care bundle for colorectal surgery versus usual care. 19,22,24,25,27,[29][30][31][32][33][34][35][36] The I 2 is 77%, indicating there is considerable heterogeneity among the studies; therefore, a random-effects model was used for the meta-analysis. There is a statistically significant differ-ence in SSI incidence following colorectal surgery, in favor of care bundle use (SSI incidence 7% [507/7,513], care bundle group, vs 13% [760/5,729], usual care).…”

Section: Primary Outcome: Ssi Developmentmentioning

confidence: 99%

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The Impact of Care Bundles on the Incidence of Surgical Site Infections: A Systematic Review

Avşar

Patton

Sayeh

et al. 2022

Adv Skin Wound Care

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OBJECTIVE This systematic review assesses the effects of care bundles on the incidence of surgical site infections (SSIs). DATA SOURCES The search was conducted between February and May 2021, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases. STUDY SELECTION Studies were included if they used systematic review methodology, were in English, used a quantitative design, and explored the use of care bundles for SSI prevention. A total of 35 studies met the inclusion criteria, and 26 provided data conducive to meta-analysis. DATA EXTRACTION Data were extracted using a predesigned extraction tool, and analysis was undertaken using RevMan (Cochrane, London, UK). Quality appraisal was undertaken using evidence-based librarianship. DATA SYNTHESIS The mean sample size was 7,982 (median, 840) participants. There was a statistically significant difference in SSI incidence in favor of using a care bundle (SSI incidence 4%, 703/17,549 in the care bundle group vs 7%, 1,157/17,162 in the usual care group). The odds ratio was 0.55 (95% confidence interval, 0.41–0.73; P < .00001), suggesting that there is a 45% reduction in the odds of SSI development for the care bundle group. The mean validity score for all studies was 84% (SD, 0.04%). CONCLUSIONS The results indicate that implementing care bundles reduced SSI incidence. However, because there was clinically important variation in the composition of and compliance with care bundles, additional research with standardized care bundles is needed to confirm this finding.

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“…Three studies explored this variable 22,23,25 . Keenan et al 22 reported a correlation between superficial SSI occurrence and an increase in LOS (7.9 vs 4.6 days; P < .001).…”

Section: Resultsmentioning

confidence: 99%

Section: Primary Outcome: Ssi Developmentmentioning

confidence: 99%

The Impact of Care Bundles on the Incidence of Surgical Site Infections: A Systematic Review

Avşar

Patton

Sayeh

et al. 2022

Adv Skin Wound Care

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“…The effectiveness of negative pressure wound therapy on SSI reduction is multifactorial and can vary depending on the type of surgical procedure, the contamination class of the surgical wound, the type, duration, and pressure level of the negative pressure wound therapy, the duration of the operation, patient comorbidities, and perioperative care bundle giving an explanation for controversial study results [21, 29]. Shen et al [30] demonstrated a non-significant effect of negative pressure wound therapy on SSI reduction in a RCT, where 265 patients with gastrointestinal, pancreatic, or peritoneal malignancies were treated with laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Reducing Surgical Site Infection by Prophylactic Negative Pressure Wound Therapy in a Cohort of General Surgery Patients

et al. 2022

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Background: Surgical site infection (SSI) is one of the leading complications in health care. Negative pressure wound therapy (NPWT) is meanwhile widely prophylactically used for preventing SSIs. For evaluating the results of the implantation of this technique, we used the Simon single-arm study design and examine whether NPWT has a prophylactic effect on reducing SSIs in a cohort of general surgery patients. Methods: This single-arm, two-stage study includes 81 elective general surgery patients and corresponds to the Simon’s design. The sample size calculation was based on a reduction in the superficial SSI rate from 12 to 4% (power 80%, significance level 5%) using a NPWT system. In compliance with Simon’s two-Stage design, the study required the recruitment of 34 patients in stage I and 47 patients in stage II. The two-stage design method would be discarded in case of a wound infection in 3 or more patients in stage I or 6 or more patients in stage II. Using the NPWT system in the operating room, a negative pressure wound dressing was applied post-operatively and removed after 7 days. According to the criteria of the Centres for Disease Control and Prevention (CDC), post-operative wound documentation followed on day 7 and 30. Results: In stage I, no SSI was apparent. In stage II, 3 patients had SSIs (CDC grade I). Conclusion: A prophylactic NPWT can significantly reduce the wound infection rate in elective general surgery.

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“…Another strategy to reduce complication and thereby lower healthcare costs might be the introduction of surgical care bundles (SCBs) and enhanced recovery programs (ERPs) in pancreatic surgery. Over the past decade, the introduction of SCBs in colorectal and liver surgery have proven to significantly reduce surgical site infections (SSI) [ 16 , 17 ]. Various components of an SCB usually include hair removal prior to surgery, perioperative antibiotic prophylaxis, and perioperative normoglycemia and normothermia [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

The Costs of Complications and Unplanned Readmissions after Pancreatoduodenectomy for Pancreatic and Periampullary Tumors: Results from a Single Academic Center

Linnemann

Kooijman

Hilst

et al. 2021

Cancers

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Background/Objectives: Complications after pancreatoduodenectomy (PD) lead to unplanned readmissions (UR), with a two- to threefold increase in admission costs. In this study, we aimed to create an understanding of the costs of complications and UR in this patient group. Furthermore, we aimed to generate a detailed cost overview that can be used to build a theoretical model to calculate the cost efficacy for prehabilitation. Methods: A retrospective cohort analysis was performed using the Dutch Pancreatic Cancer Audit (DPCA) database of patients who underwent a PD at our institute between 2013 and 2017. The total costs of the index hospital admission and UR related to the PD were collected. Results: Of the 160 patients; 35 patients (22%) had an uncomplicated course; 87 patients (54%) had minor complications, and 38 patients (24%) had severe complications. Median costs for an uncomplicated course were EUR 25.682, and for a complicated course, EUR 32.958 (p = 0.001). The median costs for minor complications were EUR 30.316, and for major complications, EUR 42.664 (p = 0.001). Costs were related to the Comprehensive Complication Index (CCI). The median costs of patients with one or more UR were EUR 41.199. Conclusions: Complications after PD led to a EUR 4.634–EUR 16.982 (18–66%) increase in hospital costs. A UR led to a cost increase of EUR 12.567 (44%). Since hospital costs are directly related to the CCI, reduction in complications will lead to cost-effectiveness.

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

Cited by 11 publications

References 34 publications

The Impact of Care Bundles on the Incidence of Surgical Site Infections: A Systematic Review

The Impact of Care Bundles on the Incidence of Surgical Site Infections: A Systematic Review

Reducing Surgical Site Infection by Prophylactic Negative Pressure Wound Therapy in a Cohort of General Surgery Patients

The Costs of Complications and Unplanned Readmissions after Pancreatoduodenectomy for Pancreatic and Periampullary Tumors: Results from a Single Academic Center

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