Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Gynecol Oncol. 2024 Jun;185:173-179. doi: 10.1016/j.ygyno.2024.02.023. Epub 2024 Mar 1.
To evaluate the clinical outcomes pre- and post-implementation of an evidence-informed surgical site infection prevention bundle (SSIPB) in gynecologic oncology patients within an Enhanced Recovery After Surgery (ERAS) care pathway.
Patients undergoing laparotomy for a gynecologic oncology surgery between January-June 2017 (pre-SSIPB) and between January 2018-December 2020 (post-SSIPB) were compared using t-tests and chi-square. Patient characteristics, surgical factors, and ERAS process measures and outcomes were abstracted from the ERAS® Interactive Audit System (EIAS). The primary outcomes were incidence of surgical site infections (SSI) during post-operative hospital admission and at 30-days post-surgery. Secondary outcomes included total postoperative infections, length of stay, and any surgical complications. Multivariate models were used to adjust for potential confounding factors.
Patient and surgical characteristics were similar in the pre- and post-implementation periods. Evaluation of implementation suggested that preoperative and intraoperative components of the intervention were most consistently used. Infectious complications within 30 days of surgery decreased from 42.1% to 24.4% after implementation of the SSIPB (p < 0.001), including reductions in wound infections (17.0% to 10.8%, p = 0.02), urinary tract infections (UTI) (12.7% to 4.5%, p < 0.001), and intra-abdominal abscesses (5.4% to 2.5%, p = 0.05). These reductions were associated with a decrease in median length of stay from 3 to 2 days (p = 0.001). In multivariate analysis, these SSI reductions remained statistically significant after adjustment for potential confounders.
Implementation of SSIPB was associated with a reduction in SSIs and infectious complications, as well as a shorter length of stay in gynecologic oncology patients.
评估在强化术后康复（ERAS）护理路径中，在妇科肿瘤患者中实施基于证据的手术部位感染预防包（SSIPB）前后的临床结果。
比较了 2017 年 1 月至 6 月（SSIPB 前）和 2018 年 1 月至 2020 年 12 月（SSIPB 后）期间接受剖腹手术治疗妇科肿瘤的患者。使用 t 检验和卡方检验比较患者特征、手术因素以及 ERAS 互动审核系统（EIAS）中提取的 ERAS 流程措施和结果。主要结果是术后住院期间和术后 30 天手术部位感染（SSI）的发生率。次要结果包括总术后感染、住院时间和任何手术并发症。使用多变量模型调整潜在混杂因素。
在实施前后，患者和手术特征相似。实施评估表明，干预措施的术前和术中部分使用最一致。手术后 30 天内的感染并发症从 SSIPB 实施前的 42.1%降至 24.4%（p<0.001），包括伤口感染（17.0%降至 10.8%，p=0.02）、尿路感染（UTI）（12.7%降至 4.5%，p<0.001）和腹腔脓肿（5.4%降至 2.5%，p=0.05）的减少。这与中位住院时间从 3 天缩短至 2 天（p=0.001）相关。在多变量分析中，在调整潜在混杂因素后，这些 SSI 减少仍然具有统计学意义。
在妇科肿瘤患者中实施 SSIPB 与 SSI 和感染性并发症的减少以及住院时间的缩短相关。
