BACKGROUND: Postoperative infections are a costly and morbid complication. The introduction of perioperative infection prevention bundles have decreased surgical site infections (SSIs) in patients undergoing colorectal and pancreatic surgery. AIM: The purpose of this study was to determine if the implementation of a perioperative bundle would reduce postoperative infectious complications in patients undergoing hepatic surgery. METHODS: An evidence-based, low cost, perioperative infection bundle was created, and a retrospective review of a prospectively maintained database was performed on 163 consecutive patients undergoing hepatic surgery. Patient characteristics, operative details, outcomes, and complications were reviewed, and differences pre- and post-bundle were assessed with univariate and multivariate analyses. RESULTS: A total of 113 patients receivedstandard infection prophylaxis, while 50 received the perioperative bundle. Twenty-five patients had infections (16 deep abscesses, 3 superficial SSIs, 4 urinary tract infections, 1 pneumonia, 1 bacteremia). The overall infection rate decreased from 20.4 % (23/133) pre-bundle to 4 % (2/50) post-bundle. The SSI rate also decreased from 15 % (17/113) to 4 % (2/50). Univariate analysis showed that institution of the bundle was associated with a lower overall infection rate (p = 0.008), lower SSI rate (p = 0.06), and lower overall complication rate (p = 0.04). Multivariate analysis confirmed that the use of the bundle was independently associated with a lower infection (p = 0.008) and SSI (p = 0.05) rate. The primary length of stay (LOS) and LOS for 60 days postoperatively both significantly decreased post-bundle (from median of 5-4 days, p ≤ 0.001; 6-4 days, p ≤ 0.001). CONCLUSIONS: Implementation of a perioperative infection prevention bundle significantly decreased overall infections, SSIs, and postoperative LOS in patients undergoing hepatic surgery.
RCT Entities:
BACKGROUND:Postoperative infections are a costly and morbid complication. The introduction of perioperative infection prevention bundles have decreased surgical site infections (SSIs) in patients undergoing colorectal and pancreatic surgery. AIM: The purpose of this study was to determine if the implementation of a perioperative bundle would reduce postoperative infectious complications in patients undergoing hepatic surgery. METHODS: An evidence-based, low cost, perioperative infection bundle was created, and a retrospective review of a prospectively maintained database was performed on 163 consecutive patients undergoing hepatic surgery. Patient characteristics, operative details, outcomes, and complications were reviewed, and differences pre- and post-bundle were assessed with univariate and multivariate analyses. RESULTS: A total of 113 patients received standard infection prophylaxis, while 50 received the perioperative bundle. Twenty-five patients had infections (16 deep abscesses, 3 superficial SSIs, 4 urinary tract infections, 1 pneumonia, 1 bacteremia). The overall infection rate decreased from 20.4 % (23/133) pre-bundle to 4 % (2/50) post-bundle. The SSI rate also decreased from 15 % (17/113) to 4 % (2/50). Univariate analysis showed that institution of the bundle was associated with a lower overall infection rate (p = 0.008), lower SSI rate (p = 0.06), and lower overall complication rate (p = 0.04). Multivariate analysis confirmed that the use of the bundle was independently associated with a lower infection (p = 0.008) and SSI (p = 0.05) rate. The primary length of stay (LOS) and LOS for 60 days postoperatively both significantly decreased post-bundle (from median of 5-4 days, p ≤ 0.001; 6-4 days, p ≤ 0.001). CONCLUSIONS: Implementation of a perioperative infection prevention bundle significantly decreased overall infections, SSIs, and postoperative LOS in patients undergoing hepatic surgery.
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: Stefan D Holubar; Traci Hedrick; Ruchir Gupta; John Kellum; Mark Hamilton; Tong J Gan; Monty G Mythen; Andrew D Shaw; Timothy E Miller Journal: Perioper Med (Lond) Date: 2017-03-03