An interventional nationwide surveillance program lowers postoperative infection rates in elective colorectal surgery. A cohort study (2008–2019)

Arroyo-García, Nares; Badia, Josep M.; Vázquez, Ana María; Pera, Miguél; Parés, David; Cáceres, Enrique Limón; Almendral, Alexander; López‐Contreras, Joaquín; Díez, Cecilia; Fraccalvieri, Doménico; López-Contreras, Joaquı́n; Pujol, Miquel; Asensio, Mireia Puig; Abad, Anna; López, Lucrecia; Castellana, D.; González, Elisa Montiu; Pardo, Graciano García; Villaró, Francesc Feliu; Fatsini, Josep Rebull; Spaneda, M. France Domènech; Galí, Marta Conde; Pérez-Hita, Anna Oller; Martín, L. Gajate; Lérida, Ana; Biondo, Sebastiano; Martínez, Emilio Jiménez; Galindo, Nieves Sopena; Ausàs, Ignasi Camps; Ferrer, Carmen; Salas, Luis Clemente; Vidal, Rafael; Rubio, Dolors Mas; Red, Irene García de la; Castillo, Ma Angels Iruela; Gil, Eva Palau i; Martínez, José Antonio Martínez; Navarro, Ma Blanca Torralbo; López, María Dolores; Porta, Carol; Smithson, Àlex; Escudero, Guillen Vidal; Redondo, José Carlos de la Fuente; Espés, Montse Rovira; Fidalgo, Arantxa Mera; Almazán, Luis Escudero; Raya, Monserrat Ortega; Gomila-Grange, Aina; Diaz-Brito, Vicens; Moya, Ma Carmen Álvarez; Palafox, Laura Grau; Gómez, Yésika Angulo; Codina, Anna Besolí; Ricard, Carme Autet; López, Carlota Hidalgo; Damieta, Marta Pascual; Pedragosa, Jordi; López, Demelsa Ma Maldonado; Blancas, David; Rubio, Esther Moreno; Aguilera, Roser Ferrer i; Iftimie, Simona Iftimie; Castro, Antoni; Serra, Maria Carmen Sabidó; Ros, Núria Bosch; Solchaga, Virginia Pomar; Marabaján, Marta Piriz; Garcia, Laura Lázaro; Ribas, Angeles Boleko; Luque, Jordi Palacín; Moise, Alexandra Lucía; Palomares, Ma Carmen Fernández; Sopeña, Santiago Barba; Huertas, Eduardo Sáez; Estada, Sara Burges; Leris, Josep María Tricas; Ruiz, Eva Redon; Brugués, M.; Acedo, Susana Otero; Esteve, Maria Cuscó; Gabarró, Lourdes; Vargas-Machuca, Fco.José; Ramírez, Ma de Gracia García; Díez, Elena Vidal; Bellés, Ana Maria Ciscar; Morón, Mariló Marimón; Sáez, Marisol Martínez; Farguell, Josep; Saballs, M.; Franco, Montserrat Vaqué; Garcia, Leonor Invernón; Enguídanos, Rosa Laplace; Marrugat, Meritxell Guillemat; Conde, Ana Coloma; González, Lucrecia López

doi:10.1016/j.ijsu.2022.106611

Cited by 11 publications

(7 citation statements)

References 37 publications

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“…The use of laparoscopy has been steadily increasing in recent years, both nationally (Table 2) and internationally, 25,26 and its progressive introduction has been shown to work as a protective factor not only for overall and incisional SSI but also for organ-space SSI. 27 These results suggest that although these risk factors cannot be entirely eliminated, there is still a considerable margin to decrease their prevalence and, thus, their impact on SSI incidence. Nonmodifiable variables estimates are mainly dependent on the wound classification, in which the estimate has low precision.…”

Section: Discussionmentioning

confidence: 97%

Surveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors

Malheiro

Peleteiro

Silva³

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: The incidence of surgical site infection (SSI) is highest after colorectal surgery. We assessed the impact of risk factors for SSI using the population attributable fraction (PAF). Design: Retrospective cohort study. Setting: Portuguese hospitals performing regular surveillance. Patients: We identified patients who underwent colorectal procedures in hospitals that reported colorectal surgeries every year between 2015 and 2019. Among 42 reporting hospitals, 18 hospitals were included. Methods: Risk-factor incidence was estimated using the National Epidemiological Surveillance platform from 2015 to 2019. This platform follows the methodology recommended by the European Centre for Disease Prevention and Control. American Society of Anaesthesiologists (ASA) physical classification, wound classification, open surgery, urgent operation, antibiotic prophylaxis, operation time, and male sex were included as risk factors. Measures of association were retrieved from published meta-analyses. PAFs were calculated using the Levin formula. To account for interaction between risk factors, communality of risk factors was used in a weighted-sum approach, providing a combined value that serves as a measure of the comprehensiveness of surveillance. Results: Among 11,219 reported procedures, the cumulative SSI incidence was 16.8%. The proportion of SSI attributed to all risk factors was 61%. Modifiable variables accounted for 31% of procedures; the highest was laparotomy (16.8%), and urgent operations (2.7%) had the lowest value. Nonmodifiable factors accounted for 28.7%; the highest was wound classification (14.3%). Conclusions: A relevant proportion (39%) of SSI remains unaccounted for by current surveillance. Almost one-third of SSI cases have potentially modifiable factors. Interventions focusing on shorter, less invasive procedures may be optimally effective in reducing the SSI incidence.

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Section: Discussionmentioning

confidence: 97%

Surveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors

Malheiro

Peleteiro

Silva³

et al. 2023

Infect. Control Hosp. Epidemiol.

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“…Data from 55 hospitals participating in the network were included in the analysis. The program is described in detail on the institutional website 29 and also in previous publications 7 , 30 .…”

Section: Methodsmentioning

confidence: 99%

Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study

Badía

Arroyo-García

Vázquez

et al. 2023

International Journal of Surgery

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Background: Bundled interventions usually reduce surgical site infection (SSI) when implemented at single hospitals, but the feasibility of their implementation at the nationwide level and their clinical results are not well established. Materials and Methods: Pragmatic interventional study to analyze the implementation and outcomes of a colorectal surgery care bundle within a nationwide quality improvement program. The bundle consisted of antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation, laparoscopy, normothermia, and a wound retractor. Control group (CG) and Intervention group (IG) were compared. Overall SSI, superficial (S-SSI), deep (D-SSI), and organ/space (O/S-SSI) rates were analyzed. Secondary endpoints included microbiology, 30-day mortality, and length of hospital stay. Results: A total of 37 849 procedures were included, 19 655 in the CG and 18 194 in the IG. In all, 5462 SSIs (14.43%) were detected: 1767 S-SSI (4.67%), 847 D-SSI (2.24%), and 2838 O/S-SSI (7.5%). Overall SSI fell from 18.38% (CG) to 10.17% (IG), odds ratio (OR) of 0.503 [0.473–0.524]. O/S-SSI rates were 9.15% (CG) and 5.72% (IG), OR of 0.602 [0.556–0.652]. The overall SSI rate was 16.71% when no measure was applied and 6.23% when all six were used. Bundle implementation reduced the probability of overall SSI (OR: 0.331; CI95: 0.242–0.453), and also O/S-SSI rate (OR: 0.643; CI95: 0.416–0.919). In the univariate analysis, all measures except normothermia were associated with a reduction in overall SSI, while only laparoscopy, OAP, and mechanical bowel preparation were related to a decrease in O/S-SSI. Laparoscopy, wound retractor, and OAP decreased overall SSI and O/S-SSI in the multivariate analysis. Conclusions: In this cohort study, the application of a specific care bundle within a nationwide nosocomial infection surveillance system proved feasible and resulted in a significant reduction in overall and O/S-SSI rates in the elective colon and rectal surgery. The OR for SSI fell between 1.5 and 3 times after the implementation of the bundle.

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“…Mandatory active surveillance after discharge is conducted until postoperative day 30 using a multimodal approach, including electronic review of medical records (with access to out-of-hospital care notes), verification of readmissions, verification of emergency department visits, and review of microbiological and radiological data. On a regular basis, audits of the data provided by the hospitals are carried out to ensure the accuracy of the programme data [5]. All cases of rectal surgery included in the VINCat system during the two periods analysed were included in the study.…”

Section: Data Sourcementioning

confidence: 99%

“…Surgical site infections (SSI) are among the most common postoperative complications, associated with increased morbidity, mortality, and healthcare-related costs [2,3]. These infections can occur following any surgical procedure; however, CRC surgery has the highest incidence after elective abdominal procedure (9-20%) 4,5 .…”

Section: Introductionmentioning

confidence: 99%

“…Data mainly come from the review of medical documentation by a team of external auditors, with full coverage of patients receiving treatment in the public system; one indicator included in these compulsory audits is the occurrence of O/S-SSI 18 . On the other hand, the Catalan Healthcare-associated Infections Surveillance Programme (VINCat) is a network spanning all across centres, which has been conducting surveillance in colorectal surgery since 2008 5 . The two systems thus operate with an important difference: the CCP audits are mandatory and cover all cancer surgeries performed in centres funded through the public healthcare system, while VINCat is a voluntary registry programme among participating centres [19].…”

Section: Introductionmentioning

confidence: 99%

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Quality check: concordance between two monitoring systems for postoperative organ/space-surgical site infections in rectal cancer surgery. Linkage of data from the Catalan Cancer Plan and the VINCat infection surveillance programme

Matallana,

Pera,

Espin-Basany

et al. 2024

World J Surg Onc

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Background The Catalan Cancer Plan (CCP) undertakes periodic audits of cancer treatment outcomes, including organ/space surgical site infections (O/S-SSI) rates, while the Catalan Healthcare-associated Infections Surveillance Programme (VINCat) carries out standardized prospective surveillance of surgical site infections (SSI) in colorectal surgery. This cohort study aimed to assess the concordance between these two monitoring systems for O/S-SSI following primary rectal cancer surgery. Methods The study compared O/S-SSI incidence data from CCP clinical audits versus the VINCat Programme in patients undergoing surgery for primary rectal cancer, in 2011-12 and 2015-16, in publicly funded centres in Spain. The main outcome variable was the incidence of O/S-SSI in the first 30 days after surgery. Concordance between the two registers was analysed using Cohen’s kappa. Discordant cases were reviewed by an expert, and the main reasons for discrepancies evaluated. Results Pooling data from both databases generated a sample of 2867 patients. Of these, O/S-SSI was detected in 414 patients—235 were common to both registry systems, with satisfactory concordance (κ = 0.69, 95% confidence interval 0.65–0.73). The rate of discordance from the CCP (positive cases in VINCat and negative in CCP) was 2.7%, and from VINCat (positive in CCP and negative in VINCat) was 3.6%. External review confirmed O/S-SSI in 66.2% of the cases in the CCP registry and 52.9% in VINCat. Conclusions This type of synergy shows the potential of pooling data from two different information sources with a satisfactory level of agreement as a means to improving O/S-SSI detection. ClinicalTrials.gov Identifier: NCT06104579. Registered 30 November 2023.

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An interventional nationwide surveillance program lowers postoperative infection rates in elective colorectal surgery. A cohort study (2008–2019)

Cited by 11 publications

References 37 publications

Surveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors

Surveillance of surgical site infection after colorectal surgery: comprehensiveness and impact of risk factors

Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study

Quality check: concordance between two monitoring systems for postoperative organ/space-surgical site infections in rectal cancer surgery. Linkage of data from the Catalan Cancer Plan and the VINCat infection surveillance programme

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