Reduction Strategies Improve Surgical Site Infection Rate After Colon Surgery

Introduction of a surgical site infection (SSI) reduction bundle significantly improved 30-day SSI rates among gynecologic cancer patients undergoing colon surgery, according to a study presented at the 2017 Society of Gynecologic Oncology Annual Meeting.¹

SSIs are associated with increased morbidity, prolonged hospitalization, and death among patients undergoing colorectal procedures. The purpose of this study was to evaluate the effect of an SSI reduction bundle at reducing infection rates.

The single-center study enrolled 233 gynecologic patients undergoing colon surgery prior to (115 patients) and after (118 patients) implementation of the SSI reduction bundle. The SSI reduction bundle included preoperative oral antibiotics, optional mechanical bowel preparation, skin preparation with an antibacterial solution, and separate surgical closing tray.

Baseline characteristics of the patients, including age, body mass index, ASA score, diabetes, smoking, and tumor type, were similar. The majority of patients in both cohorts underwent low anterior resection, and 20% and 13% of cases were emergent in the cohorts prior to and post SSI reduction bundle implementation, respectively.

At 30 days, the incidence of SSI was significantly lower in patients who were treated with the SSI reduction bundle compared with patients who underwent surgery prior to bundle implementation (12% vs 37%; P ≤ .001). This benefit was also observed in patients with a long operation time (longer than 360 minutes) and blood loss greater than 500 cc.

Wound dehiscence occurred in fewer patients who received the SSI reduction bundle compared with patients who did not receive the reduction bundle (2% vs 26%; P ≤ .001).

The results of this study show that implementation of strategies to reduce SSI can improve SSI rates, despite risk factors for infection.

Reference

1. Schiavone MB, Moukarzel LA, Leong K, et al. Incidence of surgical site infection after implementation of a reduction bundle in gynecologic cancer patients undergoing colon surgery at a comprehensive cancer center. Paper presented at: 48^th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.