Department of Surgery, College of Medicine, University of Arizona, Tuscon, Arizona.
Department of Surgery, College of Medicine, University of Arizona, Tuscon, Arizona.
J Surg Res. 2020 Feb;246:100-105. doi: 10.1016/j.jss.2019.08.018. Epub 2019 Sep 26.
Surgical site infection (SSI) is an established quality indicator and predictor for adverse patient outcomes. Multiple strategies have been established to reduce SSI; however, optimum protocol remains unclear. The aim of the study was to assess the impact of established protocol on SSI after colon surgery.
We established a colon SSI bundle in 2017, which includes a chlorhexidine prescrub followed by chloraPrep, betadine wound wash, antibiotic infused irrigation, use of closure tray, and incision coverage with silver impregnated dressing. Retrospective analysis of a 2-y (2016-2017) prospectively collected before and after analysis of all patients undergoing elective colon surgery was performed. Patients were divided into two groups: preprotocol (PP: year 2016) and postprotocol (PoP: year 2017). Patients in the two groups were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication of procedure, and procedure type. Outcome measures were SSI, hospital length of stay, and readmission rate.
A total of 328 patients were analyzed, and after propensity matching, 94 patients (PP:47 and PoP:47) were included. The mean age was 63.7 ± 16.4 y, 43.6% male, and 44.6% of procedures were performed laparoscopically. There was no difference in demographics, comorbidities, and procedure details between two groups. PoP patients had significantly lower superficial (odds ratio: 0.91 [0.74-0.98]; P = 0.045) and deep SSI (odds ratio:0.97 [0.65-0.99]; P = 0.048) than PP patients. PoP patient had shorter length of stay (P = 0.049) and trend toward lower readmission rate (P = 0.098) compared with PP patients and an 85% reduction in the Centers for Medicare and Medicaid Services standardized infection rate.
Protocol-driven patient care improves patient outcomes. SSI bundle reduced SSI in patient undergoing colon surgery. Establishing national SSI bundles will help standardize care and help optimize patient outcomes.
手术部位感染（SSI）是既定的质量指标和不良患者预后的预测因素。已经建立了多种策略来降低 SSI；然而，最佳方案仍不清楚。本研究的目的是评估结直肠手术后既定方案对 SSI 的影响。
我们在 2017 年建立了结直肠 SSI 捆绑包，其中包括氯己定预清洗，随后是氯己定 Prep、Betadine 伤口冲洗、抗生素灌注冲洗、使用闭合托盘以及用银浸渍敷料覆盖切口。对所有择期结直肠手术患者的前瞻性收集进行了 2 年（2016-2017 年）的回顾性分析。将患者分为两组：方案前（PP：2016 年）和方案后（PoP：2017 年）。使用年龄、性别、合并症、麻醉严重程度评分、手术指征和手术类型的倾向评分匹配对两组患者进行匹配。观察指标为 SSI、住院时间和再入院率。
共分析了 328 例患者，经倾向评分匹配后，94 例患者（PP：47 例，PoP：47 例）纳入研究。平均年龄为 63.7±16.4 岁，43.6%为男性，44.6%的手术为腹腔镜手术。两组患者的人口统计学、合并症和手术细节无差异。PoP 患者的浅层 SSI（比值比：0.91[0.74-0.98]；P=0.045）和深部 SSI（比值比：0.97[0.65-0.99]；P=0.048）发生率明显低于 PP 患者。与 PP 患者相比，PoP 患者的住院时间更短（P=0.049），再入院率有下降趋势（P=0.098），而医疗保险和医疗补助服务中心的标准化感染率降低了 85%。
以方案为导向的患者护理可改善患者预后。结直肠手术后的 SSI 捆绑包降低了 SSI 发生率。建立国家 SSI 捆绑包将有助于规范护理并优化患者预后。
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