C. L. Antonacci1, D. Armellino2, K. Cifu-Tursellino2, M. E. Schilling2, S. Dechario2, G. Husk2, M. Jarrett2, A. Antonacci2 1Tulane University School Of Medicine,New Orleans, LA, USA 2North Shore University And Long Island Jewish Medical Center,Manhasset, NY, USA
Introduction:
In addition to increased patient morbidity and mortality, National Surgical Quality Improvement Program 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 checklist, monthly communication of outcome data to practitioners and analysis of factors contributing to organ space infection, as defined by the National Healthcare Safety Network (NHSN).
Methods:
A colectomy bundle checklist was utilized to gather information on clinical practice from 761 colectomy cases within our system from 1/1/2016 to 12/31/2017. Data was entered into a relational database analyzing over 50 patient, procedure, SSI and bundle compliance elements at the system, hospital and surgeon level. Documentation compliance with the checklist items was compared to surgeon specific NHSN infection rates (< 2.5% and > 2.5%) by paired Student’s t-test.
Results:
Compared to 2016, elective post-colectomy SSIs for our health system in 2017 were reduced by 33% with a 45.3% reduction in intrabdominal infections, a 71.4% reduction in deep space infections and a 6.1% reduction in superficial site infections. Bundle checklist compliance was analyzed with respect to pre-operative use of oral antibiotics, mechanical bowel prep, and intra-operative re-dosing of IV antibiotics. Of 540 elective colectomy cases, 420 (77.78%) were in compliance with regard to oral antibiotics, 468 (86.67%) with mechanical bowel prep, and 441 (81.67%) with re-dosing IV antibiotics. Of 39 surgeons with checklist data and NHSN reported infections, 4 (10.26%) had infection rates less than 2.5%, while 35 (89.74%) had infection rates greater than 2.5%. Statistically significant differences were observed in checklist compliance between surgeons with infection rates <2.5% and >2.5%, respectively, for: (1) oral antibiotics 186/217 (85.7%) v. 87/134 (64.9%), p < 0.002; and (2) mechanical bowel prep 194/217 (89.4%) v. 36/65 (55.5%), p<0.006. The use of intra-operative re-dosing of IV antibiotics 171/217 (78.8%) v. 113/130 (86.9%) was not significantly different.
Conclusion:
These data suggest that implementing a system-wide standardized surgical bundle checklist and relational database system can significantly reduce the incidence of elective colectomy SSIs. Analysis of bundle checklist compliance between low infection rate surgeons (<2.5%) and high infection rate surgeons (>2.5%) demonstrates significantly lower utilization of pre-operative oral antibiotic and mechanical bowel preps in high infection rate surgeons. These data further suggest that target compliance rates may need to be set in the 85% to 90% range for these bundle items to achieve optimal reductions in elective colectomy SSIs.