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Session: ePoster Monitor 5-Quality and Cost 3

eP435 - Re-examination of Surgical Site Infection Bundle in Elective Colorectal Surgery

Sunday, June 2, 2024
1:51 PM – 1:56 PM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Alexander M. Posch, DO

    Surgery Resident - PGY3
    Berkshire Medical Center
    Berkshire Medical Center
    Pittsfield, MA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • TC

    Tiffany Cheung, DO

    Surgical Resident
    Berkshire Medical Center
    Pittsfield, Massachusetts, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • MB

    Marcella Bradway, MD

    Attending Surgeon
    Berkshire Medical Center
    Pittsfield, Massachusetts, United States

    Disclosure information not submitted.

Purpose/Background: Surgical site infections (SSIs) are a well-known, unwanted complication of colorectal surgery. In October 2014, an SSI bundle was implemented at Berkshire Medical Center to reduce the rate of postoperative infections in elective colorectal surgery cases. Initial data analysis from October 2014-2016 demonstrated a decrease in SSI formation. This review is aimed at examining long term SSI rates after continued use of this bundle.Methods/Interventions: A review of 436 patients undergoing elective colorectal surgery at Berkshire Medical Center from 2017 to June 2023 (G2) was performed via our National Surgical Quality Improvement Program (NSQIP) database. Patients who underwent urgent or emergency colorectal surgery were excluded from the study. The SSI rate in G2 was compared to the pre-SSI bundle cohort (Pre), which ranged from 2010-September 2014, and to the initial post-SSI bundle implementation cohort, which ranged from October 2014-2016 (G1). The SSI bundle included preoperative chlorhexidine bath, wound protectors, weight-based antibiotic administration, redosing of antibiotics, as well as new drapes, gloves, gowns, and instruments for closing of the operative field.Results/Outcomes: The pre-SSI bundle cohort (Pre) included 211 patients, with 33 SSIs (15.6%). The initial post SSI bundle cohort (G1) included 245 patients, yielding 4 SSIs (1.6%). In the long-term group (G2), there were 18 SSIs in 436 patients (4.12%). Within G2, mean length of stay (LOS) was reduced in patients who did not develop SSI compared to those who did develop SSI (3.32 vs 6.59 days, p = 0.09). There was no difference in 30 -day post-op mortality between groups in G2 (SSI: N = 1, 5.5%; Non-SSI: N = 1, 0.24%, p =0.31). Readmission rate within G2 was significantly reduced in the non-SSI compared to SSI group (5% vs 66%, p < 0.005). Compared to the pre-SSI bundle cohort, SSI rates remain low in G1 and in G2 (15.6 %, 1.6%, 4.12%). Overall length of stay has decreased (Pre: 5.55, G1: 4.53, and G2: 3.45 days). Thirty-day mortality remained low (0.00%, 0.41%, 0.45%). Readmission rates continue to decrease with usage of the SSI bundle (Pre: 14.2%, G1: 10.2%, G2: 7.56%).Conclusion/

Discussion: The implementation of a surgical site infection bundle at Berkshire Medical Center has resulted in fewer wound complications and fewer readmissions following elective colon and rectal surgery.