Surgical Site Infection Rates Following Implementation of a Colorectal Closure Bundle in Elective Colorectal Surgeries
Surgical Site Infection Rates Following Implementation of a Colorectal Closure Bundle in Elective Colorectal Surgeries
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DOI：
10.1097/dcr.0000000000000455
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发表时间：
2015-11-01
影响因子：
3.9
通讯作者：
Phang, P. Terry
中科院分区：
文献类型：
--
作者：
Ghuman, Amandeep;Chan, Tiffany;Phang, P. Terry
背景：据报道，结直肠手术的手术部位感染率高达27%。护理束已被引入以降低手术部位感染率，但在组成上是可变的。目的：本研究旨在确定在我们的增强术后恢复路径中添加结直肠闭合束是否降低了手术部位感染率。设计：这是一项回顾性研究，在添加闭合束之前和之后进行了择期结肠切除术。设置：本研究是在一个单一的学术机构进行的。患者：2012年12月至2014年7月31日，接受连续择期结肠切除术与初级吻合术的患者，参加了我们的术后增强恢复途径。排除标准为造口创建和闭合以及术前放化疗。干预：结肠直肠闭合束，包括更换手术服和手套，重新铺巾，伤口灌洗和一套新的闭合器械，被添加到术后增强恢复路径中。主要结局指标：测量的主要结局为CDC标准定义的手术部位感染。结果：205例患者进行了审查，111干预前和94干预后。总体手术部位感染率在干预前为25.2%，干预后为26.6%（p = 0.82）。手术部位感染细分为浅表和深部以及器官间隙，干预前分别为14.4%和10.8%，干预后分别为14.9%和11.7%（p =不显著）。多变量分析显示，吸烟和糖尿病与手术部位感染独立相关，校正优势比为4.32（95% CI，1.70-10.94），p = 0.002和2.87（95%CI 1.30-6.34），p = 0.009。局限性：局限性包括研究的回顾性和样本量小。实施结直肠闭合束后，手术部位感染率没有变化。吸烟和糖尿病是与手术部位感染增加相关的唯一显著风险因素。我们的感染率仍然很高，需要进一步改变我们的围手术期方案。
BACKGROUND: Surgical site infections of up to 27% are reported for colorectal surgery. Care bundles have been introduced to decrease surgical site infection rates, but are variable in composition.OBJECTIVE: This study aimed to determine whether the addition of a Colorectal Closure Bundle in our Enhanced Recovery After Surgery pathway decreased surgical site infection rates.DESIGN: This is a retrospective study of elective colon resections before and after the addition of a closure bundle.SETTINGS: This study was conducted at a single academic institution.PATIENTS: Patients undergoing consecutive elective colon resections with primary anastomosis, December 2012 to July 31, 2014, enrolled in our Enhanced Recovery After Surgery pathway. Exclusion criteria were stoma creation and closure and preoperative chemoradiation.INTERVENTION: The Colorectal Closure Bundle, which includes a change in gown and gloves, redraping, wound lavage, and a new set of instruments for closure, was added to the Enhanced Recovery After Surgery pathway.MAIN OUTCOME MEASURE: The primary outcome measured was surgical site infections as defined by CDC criteria.RESULTS: Two hundred five patients were reviewed, 111 preintervention and 94 postintervention. Overall surgical site infection rates were 25.2% preintervention vs 26.6% postintervention (p = 0.82). Surgical site infections were subdivided into superficial and deep and organ space and were 14.4% and 10.8% preintervention vs 14.9% and 11.7% postintervention (p = not significant). Smoking and diabetes mellitus were found to be independently associated with surgical site infections on multivariate analysis, with adjusted odds ratios of 4.32 (95% CI, 1.70-10.94), p = 0.002, and 2.87 (95% CI 1.30-6.34), p = 0.009.LIMITATIONS: Limitations include the retrospective nature of the study and the small sample size.CONCLUSIONS: There was no change in surgical site infection rates after implementation of the Colorectal Closure Bundle. Smoking and diabetes mellitus were the only significant risk factors associated with increased surgical site infections. Our infection rates remain high and further change in our perioperative protocol is needed.