Diminishing surgical site infections after colorectal surgery with surgical care improvement project: is it time to move on?

BACKGROUND

Surgical site infections are a major source of expense and morbidity after colon resection.

OBJECTIVE

This study aimed to assess the effect of a targeted intervention to improve compliance with Surgical Care Improvement Project measures on the incidence of surgical site infection.

STUDY DESIGN

A cohort of patients was prospectively monitored.

SETTING

The investigation was conducted at a university teaching hospital.

PATIENTS

Consecutive patients underwent open colon resection with anastomosis.

INTERVENTION

A multidisciplinary committee consisting of a surgeon, anesthesiologist, nurses, and quality specialists was convened in late 2004 and a series of initiatives were designed, implemented, and tracked to improve performance on the 4 infection-related components of the Surgical Care Improvement Project program.

MAIN OUTCOME MEASURES

Compliance with the 4 Surgical Care Improvement Project process measures and the rate of surgical site infection were documented.

RESULTS

There was no improvement in the use of appropriate antibiotics (P = .66), administration within 1 hour of incision (P = .11), cessation within 24 hours (P = .36), or achievement of normothermia (P = .46). Similarly, there was no effect whatsoever on the incidence of surgical site infection over the study period (P = .84).

LIMITATIONS

The single-institution nature of the study limited its usefulness.

CONCLUSIONS

A 5-year multidisciplinary program of targeted initiatives and interventions failed to improve compliance with Surgical Care Improvement Project measures or to decrease surgical site infection at our institution where colon resections are performed almost exclusively by high-volume specialists. These efforts consumed considerable resources and expenditures, but were of little or no value in our setting.