Rumberger Lindsay K, Vittetoe Debra, Cathey Lorene, Bennett Harriet, Heidel Robert E, Daley Brian J
University of Tennessee Medical Center at Knoxville, Southeastern Surgical Congress, Knoxville, Tennessee, USA.
Am Surg. 2016 Apr;82(4):325-30.
Our hospital, a Tennessee Surgical Quality Collaborative (TSQC) member, adopted a statewide colorectal care bundle intended to reduce surgical site infections (SSI) in elective colorectal cases. The bundle includes proper antibiotics/dosing, normoglycemia, normothermia, supplemental oxygen six hours postoperatively, and early enteral nutrition. A single-institution retrospective study of our National Surgical Quality Improvement Program (NSQIP) database for the rates of SSI before and after the colorectal bundle. We compared our SSI rates to TSQC hospitals as well as NSQIP datasets. Because of low case numbers in the NSQIP data, National Healthcare Safety Network (NHSN) data collected at our institution was used to compare our colorectal SSI before and after our colorectal bundle. From January 2010 to December 2011, 188 patients underwent nonemergent colorectal surgery in the NSQIP data. Of these, 5.4 per cent (10/188) developed superficial SSIs. During this same time, the rate of the TSQC superficial SSI was 7.1 per cent and NSQIP was 7.8 per cent. From January 2013 to October 2014, after the colorectal bundle started, 76 patients in NSQIP underwent nonemergent colorectal surgery. Of these, 6.5 per cent (5/76) developed superficial SSI, compared with 5.5 per cent in TSQC and 5.5 per cent in NSQIP. NHSN data showed a prebundle rate of 11 per cent and a postbundle rate of 3.5 per cent (P < 00.1, χ(2)). After adopting a colorectal bundle aimed at reducing SSIs, we did not improve our SSI rates in NSQIP; however, our NHSN data demonstrated considerable improvement. Differences in data collection may affect SSI rates, and ultimately "quality" based reimbursement. Implementation of the bundle did improve outcomes in colorectal surgery.
我们医院是田纳西州外科质量协作组织（TSQC）的成员，采用了一项全州范围的结直肠护理综合措施，旨在降低择期结直肠手术的手术部位感染（SSI）发生率。该综合措施包括合理使用抗生素/给药剂量、血糖正常、体温正常、术后6小时补充氧气以及早期肠内营养。我们对国家外科质量改进计划（NSQIP）数据库进行了一项单机构回顾性研究，以分析结直肠护理综合措施实施前后的SSI发生率。我们将我们的SSI发生率与TSQC医院以及NSQIP数据集进行了比较。由于NSQIP数据中的病例数较少，我们使用在本院收集的国家医疗安全网络（NHSN）数据来比较结直肠护理综合措施实施前后的结直肠SSI发生率。在2010年1月至2011年12月期间，NSQIP数据中有188例患者接受了非急诊结直肠手术。其中，5.4%（10/188）发生了浅表SSI。在此期间，TSQC的浅表SSI发生率为7.1%，NSQIP为7.8%。在2013年1月至2014年10月期间，结直肠护理综合措施开始实施后，NSQIP中有76例患者接受了非急诊结直肠手术。其中，6.5%（5/76）发生了浅表SSI，而TSQC为5.5%，NSQIP为5.5%。NHSN数据显示，综合措施实施前的发生率为11%，实施后的发生率为3.5%（P<0.01，χ²检验）。在采用旨在降低SSI发生率的结直肠护理综合措施后，我们在NSQIP中的SSI发生率并未得到改善；然而，我们的NHSN数据显示有显著改善。数据收集方面的差异可能会影响SSI发生率，并最终影响基于“质量”的报销。结直肠护理综合措施的实施确实改善了结直肠手术的结果。
