Tobias Joseph, Padilla Benjamin E, Lee Justin, Chen Stephanie, Wang Kasper S, Kelley-Quon Lorraine I, Mueller Claudia, Shew Stephen B, Joskowitz Katie, Ignacio Romeo C, Evans Lauren L, Jensen Aaron R, Acker Shannon N, Mason Andrew, Johnson Alicia, McConahey Jessica, Hansen Erik, Pandya Samir R, Short Scott S, Russell Katie W, Nicassio Lauren, Smith Caitlin A, Fialkowski Elizabeth
Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States.
Phoenix Children's Hospital, Phoenix, AZ, United States.
J Pediatr Surg. 2023 Jan;58(1):45-51. doi: 10.1016/j.jpedsurg.2022.09.026. Epub 2022 Sep 26.
Surgical site infection (SSI) remains a significant source of patient morbidity and resource utilization in children undergoing colorectal surgery. We examined the utility of a protocolized perioperative care bundle in reducing SSI in pediatric patients undergoing colorectal surgery.
We conducted a prospective cohort study of patients ≤18 years of age undergoing colorectal surgery at ten United States children's hospitals. Using a perioperative care protocol comprising eight elements, or "colon bundle", we divided patients into low (1-4 elements) or high (5-8 elements) compliance cohorts. Procedures involving colorectal repair or anastomosis with abdominal closure were included. Demographics and clinical outcomes were compared between low and high compliance cohorts. Compliance was compared with a retrospective cohort. The primary outcome was superficial SSI incidence at 30 days.
Three hundred and thirty-six patients were included in our analysis: 138 from the low compliance cohort and 198 from the high compliance cohort. Age and gender were similar between groups. Preoperative diagnosis was similar except for more patients in the high compliance cohort having inflammatory bowel disease (18.2% versus 5.8%, p<0.01). The most common procedure performed was small bowel to colorectal anastomosis. Wound classification and procedure acuity were similar between groups. Superficial SSI at 30 days occurred less frequently among the high compliance compared to the low compliance cohort (4% versus 9.7%, p = 0.036). Median postoperative length of stay and 30-day rates of readmission, reoperation, intra-abdominal abscess and anastomotic leak requiring operation were not significantly different between groups. None of the individual colon bundle elements were independently protective against superficial SSI.
Standardization of perioperative care is associated with a reduction in superficial SSI in pediatric colorectal surgery. Expansion of standardized protocols for children undergoing colorectal surgery may improve outcomes and decrease perioperative morbidity.
Clinical Research Paper LEVEL OF EVIDENCE: Level II.
手术部位感染（SSI）仍是接受结直肠手术儿童患者发病及资源利用的重要来源。我们研究了标准化围手术期护理套餐在降低接受结直肠手术儿科患者SSI方面的效用。
我们对美国十家儿童医院中年龄≤18岁接受结直肠手术的患者进行了一项前瞻性队列研究。使用包含八个要素的围手术期护理方案（即“结肠套餐”），我们将患者分为低（1 - 4个要素）或高（5 - 8个要素）依从性队列。纳入涉及结直肠修复或吻合并腹壁关闭的手术。比较低依从性和高依从性队列之间的人口统计学和临床结局。将依从性与一个回顾性队列进行比较。主要结局是30天时浅表SSI的发生率。
我们的分析纳入了336例患者：低依从性队列138例，高依从性队列198例。两组间年龄和性别相似。术前诊断相似，只是高依从性队列中患有炎症性肠病的患者更多（18.2%对5.8%，p<0.01）。最常进行的手术是小肠到结直肠吻合术。两组间伤口分类和手术急症程度相似。与低依从性队列相比，高依从性队列30天时浅表SSI的发生频率更低（4%对9.7%，p = 0.036）。两组间术后中位住院时间以及30天再入院率、再次手术率、腹腔内脓肿和需要手术的吻合口漏发生率无显著差异。结肠套餐的各个要素均不能独立预防浅表SSI。
围手术期护理的标准化与儿科结直肠手术中浅表SSI的减少相关。扩大针对接受结直肠手术儿童的标准化方案可能改善结局并降低围手术期发病率。
临床研究论文 证据级别：二级。
