L. Ly1, J. Cedarbaum1, Y. Chen1, A. Hjelmaas1, R. Anand1, S. Collins2, S. Regenbogen2 1University Of Michigan,Medical School,Ann Arbor, MI, USA 2University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction: With the advent of value-based purchasing for preventing healthcare-acquired infections, there is increasing interest in bundled interventions to reduce the rates of surgical site infections (SSI). In our statewide Michigan Surgical Quality Collaborative (MSQC), we previously found that compliance with six preventative measures was associated with decreased SSI rates for individual colectomy patients. We now seek to evaluate the effect of hospital-level implementation of these bundled preventative measures on overall SSI rates.
Methods: This retrospective cohort study included all elective colectomies in 59 MSQC hospitals from 2012 to 2015. In accordance with our previously published method, a “bundle score” was assigned to each case, with one point given for each SSI preventative measure followed: 1) postoperative normothermia (temperature of >98.6°F); 2) SCIP-2-compliant IV prophylactic antibiotics; 3) postoperative glycemic control (day 1 glucose ≤140 mg/dL); 4) minimally-invasive surgery; 5) oral antibiotics with mechanical bowel preparation, if used; and 6) short operations (<100 minutes). We computed Pearson correlation coefficients to compare associations between trends in hospitals’ average “bundle score” over time and their risk- and reliability-adjusted incidence of postoperative SSI.
Results: Among the study population of 4,784 cases, 298 patients developed SSIs (6.2%). Overall, 91% of patients had postoperative normothermia; 87% had appropriate IV prophylactic antibiotics; 57% had postoperative glycemic control; 57% had minimally-invasive surgeries; 49% had oral antibiotics with mechanical bowel preparation, if used; and 28% had short operative duration. The year-to-year change in hospitals’ average bundle score ranged from -0.82 to +0.87, with an average of +0.07. The change in SSI incidence ranged from -9.0% to +5.3%, with an average of -0.1%. There was a small but statistically significant negative correlation between the change in “bundle score” and the change in SSI rate at the hospital level (Pearson’s r=-0.18, p=0.02, see Figure).
Conclusion: Among MSQC hospitals, there was a wide variability in the adoption of the six SSI preventative measures. Hospitals that increased compliance with this bundle of interventions for SSI prevention in colectomy were significantly more likely to experience a decrease in the incidence of postoperative SSI. These findings suggest that efforts to further increase adoption of these preventative measures are warranted.
