Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, IL.
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, IL.
J Am Coll Surg. 2019 Jan;228(1):44-53. doi: 10.1016/j.jamcollsurg.2018.10.002. Epub 2018 Oct 22.
Surgical site infection (SSI) poses a significant burden to patients and healthcare resources. Vascular Quality Initiative (VQI) data identify a higher rate of SSIs for lower extremity bypass than other vascular procedures. Bundled interventions have successfully reduced SSIs in other surgical procedures.
We evaluated our institution-specific VQI data for modifiable risk factors associated with index hospitalization SSI from January 2012 through October 2015. We implemented an evidence-based lower extremity bypass operation SSI reduction bundle (ie perioperative chlorhexidine showers and transverse groin incisions) and prospectively enrolled all patients who had lower extremity bypass procedures, with a target adherence rate of 50% per bundle component. Bundle adherence and SSI events were measured from March 2016 through August 2017. We carried out a pre-post evaluation of bundle effectiveness in reducing index hospitalization SSI.
In the pre-intervention period, 43 of 234 (18%) patients had SSI events. The only risk factors associated with SSI (ie female sex, diabetes, overweight BMI) were not readily modifiable. In an 18-month period after introduction of our intervention, adherence rates to preoperative chlorhexidine showers, a transverse incision, and a postoperative chlorhexidine shower were 71% (52 of 73), 48% (24 of 50), and 88% (64 of 73), respectively. Compliance with all applicable bundle components was 36% (26 of 73). The SSI rate post-intervention decreased from 18% to 4% (3 of 73). Intention-to-treat multivariable analysis showed a 97% SSI risk reduction with the bundle (p = 0.002). As-treated analysis identified 85% (p = 0.02) and 62% (p = 0.047) SSI risk reductions from the preoperative and postoperative chlorhexidine showers, respectively.
In this evaluation study of the effectiveness of a quality improvement intervention, SSIs were markedly decreased after implementation of our evidence-based bundle for lower extremity vascular bypass procedures.
手术部位感染（SSI）给患者和医疗资源带来了重大负担。血管质量倡议（VQI）数据显示，下肢旁路手术的 SSI 发生率高于其他血管手术。捆绑干预措施已成功降低了其他手术中的 SSI 发生率。
我们评估了我们机构特定的 VQI 数据，以确定 2012 年 1 月至 2015 年 10 月索引住院 SSI 相关的可修改风险因素。我们实施了一项基于证据的下肢旁路手术 SSI 减少捆绑（即围手术期洗必泰淋浴和横向腹股沟切口），并前瞻性地招募了所有接受下肢旁路手术的患者，每个捆绑组件的目标依从率为 50%。从 2016 年 3 月到 2017 年 8 月，我们测量了捆绑的依从性和 SSI 事件。我们对捆绑在降低索引住院 SSI 方面的有效性进行了前后评估。
在干预前，234 例患者中有 43 例（18%）发生 SSI 事件。唯一与 SSI 相关的风险因素（即女性、糖尿病、超重 BMI）不易改变。在引入干预措施后的 18 个月内，术前洗必泰淋浴、横向切口和术后洗必泰淋浴的依从率分别为 71%（52/73）、48%（24/50）和 88%（64/73）。所有适用捆绑组件的合规率为 36%（26/73）。干预后 SSI 率从 18%降至 4%（3/73）。意向治疗多变量分析显示，该捆绑可降低 97%的 SSI 风险（p=0.002）。实际治疗分析发现，术前和术后洗必泰淋浴分别降低了 85%（p=0.02）和 62%（p=0.047）的 SSI 风险。
在这项关于质量改进干预措施有效性的评估研究中，实施我们基于证据的下肢血管旁路手术捆绑后，SSI 显著减少。
