Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA.
J Pediatr Surg. 2020 Oct;55(10):2035-2041. doi: 10.1016/j.jpedsurg.2020.01.004. Epub 2020 Jan 25.
Employing an institutional initiative to minimize variance in pediatric surgical care, we implemented a set of perioperative bundled interventions for all colorectal procedures to reduce surgical site infections (SSIs).
Implementation of a standard colon bundle at two children's hospitals began in December 2014. Subjects who underwent a colorectal procedure during the study period were analyzed. Demographics, outcomes, and complications were compared with Wilcoxon Rank-Sum, Chi-square and Fisher exact tests, as appropriate. Multivariable logistic regression was performed to assess the influence of time period (independent of protocol implementation) on the rate of subsequent infection.
One hundred and forty-five patients were identified (preprotocol=68, postprotocol= 77). Gender, diagnosis, procedure performed and wound classification were similar between groups. Superficial SSIs (21% vs. 8%, p=0.031) and readmission (16% vs. 4%, p=0.021) were significantly decreased following implementation of a colon bundle. Median hospital days, cost, reoperation, intraabdominal abscess, and anastomotic leak were unchanged before and after protocol implementation (all p > 0.05). Multivariable logistic regression found time period to be independent of SSIs (OR: 0.810, 95% CI: 0.576-1.140).
Implementation of a standard pediatric perioperative colon bundle can reduce superficial SSIs. Larger prospective studies are needed to evaluate the impact of colon bundles in reducing complications, hospital stay and cost.
III - Retrospective cohort study.
通过实施机构倡议，尽量减少小儿外科护理中的差异，我们为所有结直肠手术实施了一套围手术期捆绑干预措施，以减少手术部位感染（SSI）。
2014 年 12 月，在两家儿童医院开始实施标准结肠捆绑。对研究期间接受结直肠手术的患者进行了分析。适当采用 Wilcoxon 秩和检验、卡方检验和 Fisher 确切概率法比较人口统计学、结局和并发症。采用多变量逻辑回归评估时间段（与方案实施无关）对后续感染率的影响。
确定了 145 例患者（前方案组 68 例，后方案组 77 例）。两组之间的性别、诊断、手术方式和伤口分类相似。实施结肠捆绑后，浅表 SSI（21% vs. 8%，p=0.031）和再入院率（16% vs. 4%，p=0.021）显著降低。方案实施前后，中位住院天数、成本、再次手术、腹腔脓肿和吻合口漏均无变化（均 p > 0.05）。多变量逻辑回归发现，时间段与 SSI 无关（OR：0.810，95%CI：0.576-1.140）。
实施标准小儿围手术期结肠捆绑可减少浅表 SSI。需要更大的前瞻性研究来评估结肠捆绑在减少并发症、住院时间和成本方面的影响。
III - 回顾性队列研究。
