Isand Karl G, Saar Sten, Bahhir Artjom, Graumann Katrina, Kibuspuu Liis, Meier Marie A, Talviste Maarja, Talving Peep
North Estonia Medical Centre, Tallinn, Estonia.
World J Surg. 2025 Jul;49(7):1795-1802. doi: 10.1002/wjs.12657. Epub 2025 Jun 10.
Surgical site infections (SSI) are common complications in emergency general surgery (EGS), contributing to morbidity, prolonged hospitalization, and excessive healthcare costs. Bundled care interventions have been shown to reduce SSI rates in elective procedures, but evidence for their effectiveness in EGS remains limited. This study aimed to evaluate the impact of a multifaceted SSI prevention bundle on SSI rates in patients undergoing open EGS.
After IRB a prospective before-and-after study at a tertiary referral center between November 2020 and February 2023 was conducted. Consecutive adult patients undergoing open abdominal EGS operations were included. The pre-bundle group received standard care, whereas the intervention group was managed with an 11-point SSI prevention bundle. Centers for Disease Control and Prevention definitions of SSI were used. A doubly robust approach with inverse probability weighting and multivariable regression was deployed to adjust for confounders.
A total of 343 cases were included: 226 in the pre-bundle group and 117 in the bundle group. Adjusted analysis showed statistically significant risk reductions at 48%, 68%, and 55% for superficial, deep, and intra-abdominal infections, respectively. The bundle group had a significantly shorter median length of stay (8 vs. 13 days, p = 0.010), despite a longer operative time. No differences were observed in the Clavien-Dindo grade of the SSI or the proportion of SSIs presenting post-discharge.
Implementation of the SSI prevention bundle significantly reduced infection rates and length of hospital stay in patients undergoing EGS. These findings support the adoption of bundled strategies in emergency surgical care.
手术部位感染（SSI）是急诊普通外科（EGS）常见的并发症，会导致发病、住院时间延长和医疗费用过高。已证明综合护理干预可降低择期手术的SSI发生率，但在EGS中的有效性证据仍然有限。本研究旨在评估多方面的SSI预防综合措施对接受开放性EGS手术患者的SSI发生率的影响。
在获得机构审查委员会（IRB）批准后，于2020年11月至2023年2月在一家三级转诊中心进行了一项前瞻性前后对照研究。纳入接受开放性腹部EGS手术的成年连续患者。综合措施实施前的组接受标准护理，而干预组采用11点SSI预防综合措施进行管理。采用疾病控制与预防中心（Centers for Disease Control and Prevention）对SSI的定义。采用逆概率加权和多变量回归的双重稳健方法来调整混杂因素。
共纳入343例病例：综合措施实施前的组226例，综合措施组117例。调整分析显示，浅表、深部和腹腔内感染的风险分别显著降低48%、68%和55%。尽管手术时间较长，但综合措施组的中位住院时间显著缩短（8天对13天，p = 0.010）。在SSI的Clavien-Dindo分级或出院后出现SSI的比例方面未观察到差异。
实施SSI预防综合措施显著降低了接受EGS手术患者的感染率和住院时间。这些发现支持在急诊外科护理中采用综合策略。
