L. R. Templeton1, M. Valencia2, S. Kluger2, E. N. Hansen2, Z. M. Most3, S. R. Pandya2 1University Of Texas Southwestern Medical Center, School Of Medicine, Dallas, TX, USA 2University Of Texas Southwestern Medical Center, Division Of Pediatric Surgery, Department Of Surgery, Dallas, TX, USA 3University Of Texas Southwestern Medical Center, Division Of Infectious Disease, Department Of Pediatrics, Dallas, TX, USA
Introduction: Surgical site infection prevention “bundles” have been shown to reduce rates of surgical site infection (SSI) in adult colorectal surgery (CRS) patients. Though prophylactic antibiotics are routinely included in these surgical bundles, there is inconsistent evidence regarding antibiotic selection and timing. Our purpose was to investigate the impact of implementation of a surgical bundle standardizing prophylactic antibiotic selection and timing on incidence of SSI in pediatric CRS patients.
Methods: We performed a retrospective analysis of a prospectively collected cohort study spanning Jan 2019-Dec 2022. We compared the incidence of SSI in all CRS patients at a single institution before and after implementation of a surgical “bundle” that included pre, intra and post operative interventions. A systematic, multi-disciplinary set of guidelines were implemented January 1st, 2021. These guidelines focused on appropriate selection and timely administration of prophylactic antibiotics. Antibiotic selection and timing were each categorized either compliant or non-compliant. Compliance with both selection and timing was defined as “full compliance”. SSIs were stratified into superficial, deep incisional, and organ space infections as defined by National Healthcare Safety Network criteria. The primary outcome was incidence of SSI within 30 days of operation. The incidence of SSI from Jan 2019-Dec 2020 (“Pre”) was compared to that from Jan 2021-Dec 2022 (“Post”). Logistic regression analysis was performed.
Results: A total of 406 CRS cases were analyzed over a four-year period; 179 cases in the “Pre” group, and 227 cases in the “Post” group. Full compliance was noted in 56% of cases in the pre-bundle cohort and 88% of cases in the post-bundle cohort. There was a 55% reduction in overall SSI rate after implementation of the bundle (p= 0.039). The main driver of this reduction was the decrease in superficial SSI (p= 0.0154). Reductions in the incidence of deep and organ space SSI did not reach statistical significance. No significant relationship between SSI rates and antibiotic selection or timing was identified. A logistic regression model failed to identify antibiotic selection or timing as an independent predictor of SSI.
Conclusion: Implementation of a perioperative surgical bundle reduced superficial SSI in pediatric CRS patients at our institution. However, specific adherence to antibiotic selection and timing of administration alone were not found to be predictive for reduction in SSI rates. This may support the use of surgical bundles in SSI reduction and help secure institutional commitment to quality improvement. Further large-scale multicenter investigation may be necessary to elucidate the full impact of specific bundle components on SSI rates in pediatric CRS patients.
