S. E. Deery1, S. T. McWalters2, S. R. Reilly3, H. N. Milch1, D. W. Rattner1, E. A. Mort3,4, D. C. Hooper5, M. G. Del Carmen1,6, L. G. Bordeianou1 1Massachusetts General Hospital,Colorectal Center,Boston, MA, USA 2Massachusetts General Hospital,Edward P. Lawrence Center For Quality And Safety,Boston, MASSACHUSETTS, USA 3Massachusetts General Hospital,Department Of Patient Safety And Quality,Boston, MASSACHUSETTS, USA 4Massachusetts General Hospital,Department Of General Internal Medicine,Boston, MASSACHUSETTS, USA 5Massachusetts General Hospital,Division Of Infectious Diseases,Boston, MASSACHUSETTS, USA 6Massachusetts General Hospital,Department Of Obstetrics And Gynecology,Boston, MASSACHUSETTS, USA
Introduction:
Patient compliance with preoperative mechanical and antibiotic bowel preparation, skin washes, carbohydrate loading, and avoidance of fasting are key components of successful colorectal ERAS and surgical site infection (SSI)-reduction programs. In July 2016, we began a quality improvement project distributing a free SSI Prevention KIT (SSIPK) containing patient instructions (Figure), mechanical and oral bowel preparation, chlorhexidine washes, and carbohydrate drink to all patients scheduled for elective colectomy, with the goal of improving patient compliance and rates of SSI.
Methods:
This was a prospective data audit of our first 221 SSIPK+ patients, who were compared to historical controls (SSIPK-) of 1,760 patients undergoing elective colectomy (1/1/13–3/31/17). A 1:1 propensity score system accounted for nonrandom treatment assignment with the Chi square test to compare matched patients’ compliance and complications.
Results:
SSIPK+ (N=219) and SSIPK- (N=219) matched patients were statistically identical on demographics, comorbidities, BMI, surgical indication, surgeon, and procedure. SSIPK+ patients had higher compliance with mechanical (95% vs. 71%, P < 0.001) and oral antibiotic (94% vs. 27%, P < 0.001) bowel preparation. This translated into lower overall SSI rates (5.9% vs. 11.4%, P = .04). SSIPK+ patients also had lower rates of anastomotic leak (2.7% vs. 6.8%, P = 0.04), prolonged postoperative ileus (5.9% vs. 14.2%, P < .01), and unplanned intubation (0% vs. 2.3%, P = .02). Furthermore, SSIPK+ patients had shorter mean hospital length of stay (3.1 vs. 5.4 days, P < .01) and had fewer unplanned readmissions (5.9% vs. 14.6%, P < .001). There were no differences in rates of postoperative pneumonia, urinary tract infection, Clostridium difficile colitis, sepsis, or death.
Conclusion:
Provision of a free-of-charge SSIPK improves patient compliance with preoperative instructions, which is associated with significantly lower rates of surgical site infections, lower rates of prolonged postoperative ileus, and shorter hospital stays with fewer readmissions. Widespread utilization of such a kit could therefore lead to significantly improved outcomes and lower costs.
