Department of Surgery, Hospital General de Granollers, Granollers.
School of Medicine, Universitat Internacional de Catalunya, Sant Cugat del Vallès.
Int J Surg. 2023 Apr 1;109(4):737-751. doi: 10.1097/JS9.0000000000000277.
Bundled interventions usually reduce surgical site infection (SSI) when implemented at single hospitals, but the feasibility of their implementation at the nationwide level and their clinical results are not well established.
Pragmatic interventional study to analyze the implementation and outcomes of a colorectal surgery care bundle within a nationwide quality improvement program. The bundle consisted of antibiotic prophylaxis, oral antibiotic prophylaxis (OAP), mechanical bowel preparation, laparoscopy, normothermia, and a wound retractor. Control group (CG) and Intervention group (IG) were compared. Overall SSI, superficial (S-SSI), deep (D-SSI), and organ/space (O/S-SSI) rates were analyzed. Secondary endpoints included microbiology, 30-day mortality, and length of hospital stay.
A total of 37 849 procedures were included, 19 655 in the CG and 18 194 in the IG. In all, 5462 SSIs (14.43%) were detected: 1767 S-SSI (4.67%), 847 D-SSI (2.24%), and 2838 O/S-SSI (7.5%). Overall SSI fell from 18.38% (CG) to 10.17% (IG), odds ratio (OR) of 0.503 [0.473-0.524]. O/S-SSI rates were 9.15% (CG) and 5.72% (IG), OR of 0.602 [0.556-0.652]. The overall SSI rate was 16.71% when no measure was applied and 6.23% when all six were used. Bundle implementation reduced the probability of overall SSI (OR: 0.331; CI 95 : 0.242-0.453), and also O/S-SSI rate (OR: 0.643; CI 95 : 0.416-0.919). In the univariate analysis, all measures except normothermia were associated with a reduction in overall SSI, while only laparoscopy, OAP, and mechanical bowel preparation were related to a decrease in O/S-SSI. Laparoscopy, wound retractor, and OAP decreased overall SSI and O/S-SSI in the multivariate analysis.
In this cohort study, the application of a specific care bundle within a nationwide nosocomial infection surveillance system proved feasible and resulted in a significant reduction in overall and O/S-SSI rates in the elective colon and rectal surgery. The OR for SSI fell between 1.5 and 3 times after the implementation of the bundle.
捆绑干预措施通常可降低单家医院的手术部位感染 (SSI) 发生率，但在全国范围内实施的可行性及其临床效果尚未得到充分证实。
本研究为一项基于全国质量改进计划的结直肠手术护理捆绑干预的实用干预性研究，分析捆绑干预的实施情况和结果。捆绑干预措施包括抗生素预防、口服抗生素预防 (OAP)、机械肠道准备、腹腔镜检查、体温正常和伤口牵开器。比较了对照组 (CG) 和干预组 (IG)。分析了总 SSI、浅表 (S-SSI)、深部 (D-SSI) 和器官/腔隙 (O/S-SSI) 发生率。次要终点包括微生物学、30 天死亡率和住院时间。
共纳入 37849 例手术，CG 组 19655 例，IG 组 18194 例。共检出 5462 例 SSI（14.43%）：1767 例 S-SSI（4.67%）、847 例 D-SSI（2.24%）和 2838 例 O/S-SSI（7.5%）。总 SSI 从 CG 组的 18.38%降至 IG 组的 10.17%，优势比 (OR) 为 0.503 [0.473-0.524]。O/S-SSI 发生率分别为 CG 组的 9.15%和 IG 组的 5.72%，OR 为 0.602 [0.556-0.652]。未采取任何措施时的总 SSI 发生率为 16.71%，采用所有 6 项措施时的发生率为 6.23%。捆绑干预措施的实施降低了总 SSI 的发生概率（OR：0.331；95%CI：0.242-0.453），也降低了 O/S-SSI 发生率（OR：0.643；95%CI：0.416-0.919）。在单因素分析中，除体温正常外，所有措施均与总 SSI 降低相关，而仅腹腔镜检查、OAP 和机械肠道准备与 O/S-SSI 降低相关。腹腔镜检查、伤口牵开器和 OAP 在多因素分析中降低了总 SSI 和 O/S-SSI。
在这项队列研究中，在全国性医院感染监测系统中应用特定的护理捆绑措施是可行的，并且在择期结肠和直肠手术中显著降低了总 SSI 和 O/S-SSI 发生率。实施捆绑措施后，SSI 的比值比下降了 1.5 至 3 倍。
