A. C. Antonacci1, D. Armellino1, K. Cifu-Tursellino1, M. Schilling1, S. Dechario1, J. Nicastro1, M. Jarrett1 1North Shore University And Long Island Jewish Medical Center,Surgery,Manhasset, NY, USA
Introduction:
In addition to increased patient morbidity and mortality, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data suggest that surgical site Infection (SSI) accounts for a 9.2% increase in hospital costs above uncomplicated colectomy cases. This project, which included 12 acute care facilities , was designed to reduce the incidence of post-colectomy SSI by implementing a system-wide standardized surgical bundle, monthly communication of outcome data to practitioners and analysis of factors contributing to an organ space Infection, as defined by the National Healthcare Safety Network (NHSN), following elective colectomy.
Methods:
A colectomy bundle linked survey was utilized to gather information on clinical practice from 125 surgeons within our system. The data suggested specific deficiencies in bundle adherence particularly with respect to oral and mechanical bowel prep compliance. Postoperative compliance data was collected from post-colectomy SSIs into a relational database analyzing over 50 patient, procedure, SSI and bundle compliance elements. Data was evaluated at the system, hospital and surgeon level. Breaches in compliance were shared to the provider level.
Results:
Two years of historical data was utilized to establish the baseline incidence of SSI and compared to six months following implementation. A twenty-eight percent reduction in SSI was achieved in association with an 30% increase in the use of oral and mechanical bowel preparation. Elective and emergent procedures were analyzed separately with respect to organ space infection. Despite an 80% compliance rate with oral and mechanical bowel preparation in elective cases, 62% of the cases were identified as having infection present at the time of surgery (PATOS) and 67.5% of the cases were identified as having Class III or Class IV wounds.
Conclusion:
These data suggest that bundle compliance is important in reducing SSIs, particularly with respect to oral and mechanical bowel preparation. However, the high incidence of PATOS and Class III/IV wounds found at elective colectomy suggest that surgeons may be operating on patients too early during the course of an on-going inflammatory process and that surgical judgment and decision making should be included as bundle compliance elements.