OBJECTIVES: Patients undergoing complex hepatopancreatobiliary (HPB) operations are at high risk for surgical site infection (SSI). Factors such as biliary obstruction, operative time and pancreatic or biliary fistulae contribute to the high SSI rate. The purpose of this study was to analyse whether a multifactorial approach would reduce the incidence and cost of SSI after HPB surgery. METHODS: From January 2007 to December 2009, 895 complex HPB operations were monitored for SSI through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). In 2008, surgeon-specific SSI rates were provided to HPB surgeons, and guidelines for the management of perioperative factors were established. Observed SSI rates were monitored before and after these interventions. Hospital cost data were analysed and cost savings were calculated. RESULTS: Observed SSI for hepatic, pancreatic and complex biliary operations decreased by 9.6% over a 2-year period (P < 0.03). The excess cost per SSI was US$11 462 and was driven by increased length of stay and hospital readmission for infection. Surgeons rated surgeon-specific feedback on SSI rate as the most important factor in improvement. CONCLUSIONS: High SSI rates following complex HPB operations can be improved by a multifactorial approach that features process improvements, individual surgeon feedback and reduced variation in patient management.
OBJECTIVES:Patients undergoing complex hepatopancreatobiliary (HPB) operations are at high risk for surgical site infection (SSI). Factors such as biliary obstruction, operative time and pancreatic or biliary fistulae contribute to the high SSI rate. The purpose of this study was to analyse whether a multifactorial approach would reduce the incidence and cost of SSI after HPB surgery. METHODS: From January 2007 to December 2009, 895 complex HPB operations were monitored for SSI through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). In 2008, surgeon-specific SSI rates were provided to HPB surgeons, and guidelines for the management of perioperative factors were established. Observed SSI rates were monitored before and after these interventions. Hospital cost data were analysed and cost savings were calculated. RESULTS: Observed SSI for hepatic, pancreatic and complex biliary operations decreased by 9.6% over a 2-year period (P < 0.03). The excess cost per SSI was US$11 462 and was driven by increased length of stay and hospital readmission for infection. Surgeons rated surgeon-specific feedback on SSI rate as the most important factor in improvement. CONCLUSIONS: High SSI rates following complex HPB operations can be improved by a multifactorial approach that features process improvements, individual surgeon feedback and reduced variation in patient management.
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Authors: Chad G Ball; Henry A Pitt; Molly E Kilbane; Elijah Dixon; Francis R Sutherland; Keith D Lillemoe Journal: HPB (Oxford) Date: 2010-09 Impact factor: 3.647
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Authors: D Leaper; P Wilson; O Assadian; C Edmiston; M Kiernan; A Miller; G Bond-Smith; J Yap Journal: Ann R Coll Surg Engl Date: 2017-07 Impact factor: 1.891
Authors: Ayòtúndé B Fadayomi; Gyulnara G Kasumova; Omidreza Tabatabaie; Susanna W L de Geus; Tara S Kent; Sing Chau Ng; A James Moser; Mark P Callery; Stanley W Ashley; Jennifer F Tseng Journal: HPB (Oxford) Date: 2018-03-09 Impact factor: 3.647
Authors: Lauren S Tufts; Emma D Jarnagin; Jessica R Flynn; Mithat Gonen; Jose G Guillem; Philip B Paty; Garrett M Nash; Joshua J Smith; Iris H Wei; Emmanouil Pappou; Michael I D'Angelica; Peter J Allen; T Peter Kingham; Vinod P Balachandran; Jeffrey A Drebin; Julio Garcia-Aguilar; William R Jarnagin; Martin R Weiser Journal: HPB (Oxford) Date: 2018-08-01 Impact factor: 3.647
Authors: Zachary M Dong; Alexis P Chidi; Julie Goswami; Katrina Han; Richard L Simmons; Matthew R Rosengart; Allan Tsung Journal: HPB (Oxford) Date: 2015-09-03 Impact factor: 3.647
Authors: Eliza W Beal; Ezra Lyon; Joe Kearney; Lai Wei; Cecilia G Ethun; Sylvester M Black; Mary Dillhoff; Ahmed Salem; Sharon M Weber; Thuy B Tran; George Poultsides; Rivfka Shenoy; Ioannis Hatzaras; Bradley Krasnick; Ryan C Fields; Stefan Buttner; Charles R Scoggins; Robert C G Martin; Chelsea A Isom; Kamron Idrees; Harveshp D Mogal; Perry Shen; Shishir K Maithel; Timothy M Pawlik; Carl R Schmidt Journal: HPB (Oxford) Date: 2017-09-07 Impact factor: 3.647