Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients

Tanner, Judith; Padley, Wendy; Assadian, Ojan; Leaper, David; Kiernan, Martin; Edmiston, Charles E.

doi:10.1016/j.surg.2015.03.009

Cited by 227 publications

(154 citation statements)

References 30 publications

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“…23 Recently released systematic review has documented the variations in constituents of implemented bundles for patients undergoing colorectal surgery. 24 However, decision-making on which evidence-based or commonsensed measures will be preferred as a part of the bundle is challenging. Moreover the question of "which subset of patients could benefit the most from targeted interventions" remained unanswered.…”

Section: Discussionmentioning

confidence: 99%

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Rencüzoğulları¹,

Trunzo²,

Vogel³

et al. 2018

TJCD

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Aim: Applying prevention bundles to all patients to reduce surgical site infections (SSI) after colorectal surgery is expensive and has minimal success. The aim of this study was to identify factors associated with high-risk of superficial SSI and to assess the impact of prevention measures on high-risk patients. Method: Between January 2010 and February 2014, patients who underwent colorectal surgical procedures were separated into the pre-bundle period (January 2010-July 2012) and bundle period (August 2012-February 2014. Factors associated with superficial SSI risk were evaluated. Pre-bundle and bundle patients were categorized in deciles from low-to high-risk using a risk model. The impact of prospectively introduced protective measures was assessed in the bundle patients with multivariate modeling and frequency-matched analysis. Results: There were 2.535 pre-bundle patients who underwent ileocolic (19.1%), left-sided (46%), and pelvic (34.9%) procedures. Overall superficial SSI rate was 10.7%. Four patient-related factors and five procedure-related factors were found to be significantly associated with superficial SSI on unadjusted analysis. Comparison of pre-bundle patients on whom the risk model was built and the bundle patients used in the risk assessment showed significant decrease in superficial SSI rates (10.6% to 3.2%, p<0.001). Frequency matched analysis demonstrated a significant reduction in superficial SSI from pre-bundle to bundle patients (13.1 to 4.2%, p<0.001). Among the risk deciles in bundle patients, the reduction from the average predicted risk to the observed superficial SSI rate was most evident among the high-risk groups. Conclusion: Preventive strategies specifically aimed at patients with the highest risk for superficial SSI after colorectal surgery resulted in the highest reduction. Considering the variability of SSI rates, collaborative and targeted policies are critical to ensure efficacious and potentially cost-effective strategies. Keywords: Superficial surgical site infection, prevention bundle, colorectal surgery, high-risk patients Amaç: Kolorektal cerrahi sonrası cerrahi alan enfeksiyonlarını (CAE) azaltmak için hazırlanan önlem paketlerinin tüm hastalara uygulanması pahalı olup minimal başarıya sahiptir. Bu çalışmada yüksek riskli yüzeyel CAE'leri ile ilişkili faktörler ve koruyucu önlemlerin yüksek riskli hastalardaki etkinliğini değerlendirmek amaçlanmıştır. Yöntem: 2010 Ocak ve 2014 Şubat tarihleri arasında kolorektal eksizyon uygunlanan hastalar önlem demeti öncesi (2010 Ocak-2012 Ağustos) ve demet dönemi (2012 Ağustos-2014 Şubat) olmak üzere identifiye edildi. Yüzeyel CAE riski ile ilişkili faktörler değerlendirildi. Demet öncesi ve demet dönemi periyoduna ait hastalar risk modeli oluşturularak 1/10'luk gruplar şeklinde düşük riskten yüksek riske doğru kategorize edildi. Demet dönemi periyoduna ait hastalara prospektif olarak uygulanan koruyucu önlemlerin etkisi çok değişkenli modelleme ve frekans-eşlemeli analiz ile değerlendirildi. Bulgular: İleokolik (%19,1)...

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Section: Discussionmentioning

confidence: 99%

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Rencüzoğulları¹,

Trunzo²,

Vogel³

et al. 2018

TJCD

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“…Glycemic control is an important aspect in the prevention of surgical site infections, and occupies position of equal importance among other traditional preventive measures such as appropriate antibiotic prophylaxis, normothermia and hair removal (23) . In addition, a recent integrative review found that 23 out of 26 studies emphasized the need for glycemic control, observing an association of hyperglycemia with infections in the postoperative period, highlighting SSIs, increased morbidity, mortality, and costs during hospitalization (5) .…”

Section: Discussionmentioning

confidence: 99%

Glycemic control strategies and the occurrence of surgical site infection: a systematic review

Domingos

Iida

Poveda

2016

Rev. esc. enferm. USP

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Objective:To analyze the available evidence in the scientific literature on the relationship between glycemic control strategies performed and the occurrence of surgical site infection in adult patients undergoing surgery. Method: This is a systematic review, through the CINAHL, Medline, LILACS, Cochrane Database of Systematic Reviews, and EMBASE, which included 8 studies. Results: Despite the diversity of tested interventions, studies agree that glycemic control is essential to reduce surgical site infection rates and should be kept between 80 and 120 mg/dl during the perioperative period. Insulin continuous infusion during surgery was the most tested and seems to get better results in reducing surgical site infection rates and success in glycemic control compared to other strategies. Conclusion: Strict glycemic control during the perioperative benefits the recovery of surgical patients, especially for the successful implementation of the measure the performance of the nursing team. DESCRIPTORS

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“…Dabei waren Maßnahmen der meisten Bündel PAP, adäquate Haarentfernung, Kontrolle des Blutglukosespiegels und Normothermie [405]. In Anbetracht des hohen Stellenwerts sind auch der Einschluss der standardisierten präoperativen Hautantiseptik, sowie das präoperative risikobasierte S. aureus-Screening und ggf.…”

Section: Bündelstrategieunclassified

Prävention postoperativer Wundinfektionen

2018

Bundesgesundheitsbl

153

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Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients

Abstract: The systematic review and meta-analysis documents that use of an evidence-based, surgical care bundle in patients undergoing colorectal surgery significantly reduced the risk of SSI.

Cited by 227 publications

References 30 publications

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Glycemic control strategies and the occurrence of surgical site infection: a systematic review

Prävention postoperativer Wundinfektionen

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