Evaluating an Evidence-Based Bundle for Preventing Surgical Site Infection

Abstract

An evidence-based intervention bundle did not reduce SSIs. The bundling of interventions, even when the constituent interventions have been individually tested, does not have a predictable effect on outcome. Formal testing of bundled approaches should occur prior to implementation.

The WHO recommendation for 80% perioperative oxygen is poorly justified

“…On the other hand 7 trials including 2992 patients reported no benefit of 80% inspired oxygen (. Table 1) [2,12,13,15,20,26,28]. The WHO panel members based their recommendations on a meta-analysis of 11 randomized trials of supplemental oxygen during and after general anaesthesia.…”

“…The WHO panel members based their recommendations on a meta-analysis of 11 randomized trials of supplemental oxygen during and after general anaesthesia. Using a random effects model, they estimated the odds ratio (OR) for SSI as 0.72 (95% confidence interval CI; 0.55-0.94) in favour of 80% inspired oxygen; however, it is quite unclear why the WHO panel excluded studies by Kurz et al [12] and Anthony et al [2]. The question is critical because including the results of Kurz et al [12] and Anthony et al [2] in the metaanalysis (using the same methodology) yields an OR of 0.84 (CI: 0.62-1.12, p = 0.242), a value that no longer supports this panel's recommendation.…”

Veiksniai, Lemiantys Operacinių Žaizdų Infekcijas Pilvo Chirurgijos Skyriuose

“…Audinių pažeidimas sukelia pokyčius, kurie palaiko ir netgi sustiprina paciento jaučiamą skausmą [11,26,27]. Pooperacinio skausmo kilmę lemia impulsai, gaunami iš žaizdos, chirurginio pjūvio vietos, siūlės nervinių galū-nių, dėl to didėja pooperacinių komplikacijų skaičius, ilgėja paciento hospitalizavimo laikas [25,26,27,28,29,30]. Mūsų tyrimo rezultatai rodo, kad, ilgėjant pooperaciniam laikui, skausmo intensyvumas operacinio pjūvio vietoje mažėjo (χ 2 = 45,42, p = 0,0001).…”

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

“…1,2,3,4 It contributes to significant financial burden on the health care system as the median cost for a single SSI-related readmission is calculated to be $12.835. 5,6 Due to the nature of the colorectal flora, the risk of SSIs is consistently higher in colorectal surgery patients with a range of 5% and 45%.…”

“…5,6 Due to the nature of the colorectal flora, the risk of SSIs is consistently higher in colorectal surgery patients with a range of 5% and 45%. 1,2,4,7,8 To ensure better clinical outcomes, SSI reduction efforts are being increasingly incorporated into quality improvement strategies. 2,5 As SSI has become the most frequent complication after colorectal procedures, identification of the best practice to standardize care is of paramount importance.…”