L.W. Huang1, M.N. Perez1,2, A. Lehane1,2, Y. Tian1, J.L. Holl3, M.V. Raval1,2 1Northwestern University Feinberg School of Medicine, 1. Northwestern Quality Improvement, Research & Education In Surgery (NQUIRES), Chicago, IL, USA 2Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Division Of Pediatric Surgery, Department Of Surgery, Chicago, IL, USA 33. Department of Neurology, Biological Sciences Division and Center for Healthcare Delivery Science and Innovation, University Of Chicago, Chicago, IL, USA
Introduction: Surgical site infections (SSIs) are one of the most common complications following pediatric gastrointestinal (GI) surgery. SSIs impose significant burdens including prolonged hospitalization, increased pain/distress, and added financial costs. This study aimed to assess adherence to an SSI prevention bundle and explore its relationship to SSI occurrence in pediatric patients with inflammatory bowel disease (IBD) undergoing GI surgery
Methods: Data from a national, prospective trial conducted at 18 children’s hospitals were used. Patients, 10-18 years old, with IBD undergoing elective GI surgery from 7/2020-3/2024 were included. Co-variates pertinent to SSI, including demographics, intraoperative factors, and implementation of the SSI prevention interventions (yes/no) were abstracted from patient records. The bundle included 5 interventions: (1) prescription of combined (oral and mechanical) or no preoperative bowel regimen; (2) pre-incisional antibiotic administration; (3) use of a wound protector; (4) maintenance of normothermia; and (5) exchange of sterile gloves/instruments. SSI was defined as any superficial infection, deep space/organ infection, wound dehiscence, or need for abdominal/pelvic abscess drainage. Patients with an anastomotic leak were excluded. Descriptive statistics were calculated to assess adherence to the bundle. Factors associated with SSI were identified using hierarchical logistic regression with a random intercept for hospital site (p<0.05).
Results: Among 414 patients with IBD, 243 (59%) received a combined or no bowel prep, 385 (93%) received pre-incisional antibiotics, 138 (33%) had a wound protector, 382 (92%) had normothermia maintained, and 243 (59%) had an exchange of sterile gloves/instruments (Figure). The median number of interventions was 3 per patient (IQR 3-4), with only 48 (12%) patients receiving all 5. SSIs were observed in 29 (7%) patients. Preoperative use of a biologic or steroids increased odds of SSI by 37% and 43%, respectively, though not statistically significant. When modeled as a continuous variable, bundle adherence was not significantly associated with SSI. Other intraoperative factors (e.g., minimally invasive approach, surgery duration, and estimated blood loss) were also not significant. However, patients undergoing surgery involving an ostomy had 179% increased odds of SSI (p=0.04).
Conclusion: Adherence to the SSI prevention bundle was suboptimal in this study, though not significantly associated with SSI occurrence. Notably, only a fraction of patients received all interventions. Further research is needed to understand barriers to implementation, particularly for surgery involving an ostomy.