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Badia JM, Arroyo-Garcia N, Vázquez A, Almendral A, Gomila-Grange A, Fraccalvieri D, Parés D, Abad-Torrent A, Pascual M, Solís-Peña A, Puig-Asensio M, Pera M, Gudiol F, Limón E, Pujol M. Leveraging a nationwide infection surveillance program to implement a colorectal surgical site infection reduction bundle: a pragmatic, prospective, and multicenter cohort study. Int J Surg 2023; 109:737-751. [PMID: 36917127 PMCID: PMC10389383 DOI: 10.1097/js9.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/26/2023] [Indexed: 03/16/2023]
Abstract
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; CI 95 : 0.242-0.453), and also O/S-SSI rate (OR: 0.643; CI 95 : 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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Affiliation(s)
- Josep M. Badia
- Department of Surgery, Hospital General de Granollers, Granollers
- School of Medicine, Universitat Internacional de Catalunya, Sant Cugat del Vallès
| | - Nares Arroyo-Garcia
- Department of Surgery, Hospital General de Granollers, Granollers
- School of Medicine, Universitat Internacional de Catalunya, Sant Cugat del Vallès
| | - Ana Vázquez
- Servei d’Estadística Aplicada, Universitat Autònoma de Barcelona, Bellaterra, Barcelona
| | | | - Aina Gomila-Grange
- Department of Infectious Diseases, Hospital Universitari Parc Taulí, Sabadell
| | - Domenico Fraccalvieri
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat
| | - David Parés
- Colorectal Surgery Unit, Department of Surgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
- Universitat Autónoma de Barcelona, Catalonia
| | - Ana Abad-Torrent
- Department of Anaesthesiology, Hospital Universitari Vall d’Hebrón
| | | | | | - Mireia Puig-Asensio
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC, CB21/13/00009), Instituto de Salud Carlos III, Madrid
| | | | | | - Enric Limón
- VINCat Program, Catalonia
- Universitat de Barcelona
| | - Miquel Pujol
- VINCat Program, Catalonia
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC, CB21/13/00009), Instituto de Salud Carlos III, Madrid
- Department of Infectious Diseases, Hospital Universitari de Bellvitge
- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
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Baeza-Murcia M, Valero-Navarro G, Pellicer-Franco E, Soria-Aledo V, Mengual-Ballester M, Garcia-Marin JA, Betoret-Benavente L, Aguayo-Albasini JL. Bundles reduce anastomosis leak in patients undergoing elective colorectal surgery. A propensity score-matched study. Front Surg 2023; 10:1119236. [PMID: 36923382 PMCID: PMC10008907 DOI: 10.3389/fsurg.2023.1119236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/01/2023] [Indexed: 02/28/2023] Open
Abstract
Background anastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyse the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle. Methods Single-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bundle. Results The bundle group shown fewer complications, especially in Clavien Dindós Grade IV complications (2.3% vs. 6.2% p < 0.01), as well as a lower rate of anastomotic leakage (15.5% vs. 2.2% p < 0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p > 0.05). Conclusions The implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions. Register study The study has been registered at clinicaltrials.gov Code: nct04632446.
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Affiliation(s)
- M Baeza-Murcia
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - G Valero-Navarro
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Morales Meseguer, Murcia, Spain.,Grupo de Investigación Quirurgica en Area de Salud, Instituto Murciano de Investigación Biosanitaria Pascual Parrilla, Murcia, Spain
| | - E Pellicer-Franco
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Morales Meseguer, Murcia, Spain.,Grupo de Investigación Quirurgica en Area de Salud, Instituto Murciano de Investigación Biosanitaria Pascual Parrilla, Murcia, Spain
| | - V Soria-Aledo
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Morales Meseguer, Murcia, Spain.,Grupo de Investigación Quirurgica en Area de Salud, Instituto Murciano de Investigación Biosanitaria Pascual Parrilla, Murcia, Spain
| | - M Mengual-Ballester
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Morales Meseguer, Murcia, Spain.,Grupo de Investigación Quirurgica en Area de Salud, Instituto Murciano de Investigación Biosanitaria Pascual Parrilla, Murcia, Spain
| | - J A Garcia-Marin
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Morales Meseguer, Murcia, Spain.,Grupo de Investigación Quirurgica en Area de Salud, Instituto Murciano de Investigación Biosanitaria Pascual Parrilla, Murcia, Spain
| | - L Betoret-Benavente
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - J L Aguayo-Albasini
- Servicio de Cirugía General y Digestiva, Hospital General Universitario Morales Meseguer, Murcia, Spain.,Grupo de Investigación Quirurgica en Area de Salud, Instituto Murciano de Investigación Biosanitaria Pascual Parrilla, Murcia, Spain
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TRANSLATIONAL STUDY OF GUNSHOT INJURY TO THE COLON BY MODERN TYPES OF BULLETS. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-4-82-192-196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Badia JM, Flores-Yelamos M, Vázquez A, Arroyo-García N, Puig-Asensio M, Parés D, Pera M, López-Contreras J, Limón E, Pujol M. Oral Antibiotic Prophylaxis Lowers Surgical Site Infection in Elective Colorectal Surgery: Results of a Pragmatic Cohort Study in Catalonia. J Clin Med 2021; 10:5636. [PMID: 34884337 PMCID: PMC8658297 DOI: 10.3390/jcm10235636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures in a National Infection Surveillance Network in Catalonia. METHODS Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007-2015) with implementation phase (IP: 2016-2019). To compare the results, a logistic regression model was established. RESULTS Out of 34,421 colorectal operations, 5180 had SSIs (15.05%). Overall SSI rate decreased from 18.81% to 11.10% in BP and IP, respectively (OR 0.539, CI95 0.507-0.573, p < 0.0001). Information about bundle implementation was complete in 61.7% of cases. In a univariate analysis, OAP and MBP were independent factors in decreasing overall SSI, with OR 0.555, CI95 0.483-0.638, and OR 0.686, CI95 0.589-0.798, respectively; and similarly, organ/space SSI (O/S-SSI) (OR 0.592, CI95 0.494-0.710, and OR 0.771, CI95 0.630-0.944, respectively). However, only OAP retained its protective effect at both levels at multivariate analyses. CONCLUSIONS oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surgery.
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Affiliation(s)
- Josep M. Badia
- Department of Surgery, Hospital General Granollers, 08348 Granollers, Barcelona, Spain; (M.F.-Y.); (N.A.-G.)
- School of Medicine, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Miriam Flores-Yelamos
- Department of Surgery, Hospital General Granollers, 08348 Granollers, Barcelona, Spain; (M.F.-Y.); (N.A.-G.)
- School of Medicine, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Ana Vázquez
- Servei d’Estadística Aplicada, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain;
| | - Nares Arroyo-García
- Department of Surgery, Hospital General Granollers, 08348 Granollers, Barcelona, Spain; (M.F.-Y.); (N.A.-G.)
- School of Medicine, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Mireia Puig-Asensio
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005), 08907 L’Hospitalet del Llobregat, Barcelona, Spain; (M.P.-A.); (M.P.)
| | - David Parés
- Department of Surgery, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain;
| | - Miguel Pera
- Department of Surgery, Hospital del Mar, 08003 Barcelona, Catalonia, Spain;
| | - Joaquín López-Contreras
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08041 Barcelona, Barcelona, Spain;
| | - Enric Limón
- VINCat Program, 08028 Barcelona, Catalonia, Spain;
- Universitat de Barcelona, 08007 Barcelona, Catalonia, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005), 08907 L’Hospitalet del Llobregat, Barcelona, Spain; (M.P.-A.); (M.P.)
- VINCat Program, 08028 Barcelona, Catalonia, Spain;
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