Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study

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• dc.contributor.author Flores-Yelamos, Miriam
• dc.contributor.author Gomila-Grange, Aina
• dc.contributor.author Badia, Josep M.
• dc.contributor.author Almendral, Alexander
• dc.contributor.author Vázquez, Ana
• dc.contributor.author Parés, David
• dc.contributor.author Pascual, Marta
• dc.contributor.author Limón, Enric
• dc.contributor.author Pujol, Miquel
• dc.contributor.author Juvany, Montse
• dc.contributor.author VINCat Colorectal Surveillance Team
• dc.date.accessioned 2025-03-06T07:22:09Z
• dc.date.available 2025-03-06T07:22:09Z
• dc.date.issued 2024
• dc.description.abstract Background: There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level. Methods: A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after the sequential implementation of two preventive bundle protocols. Secondary outcomes were to determine compliance with individual measures and to establish their effectiveness, duration of stay, microbiology and 30-day mortality rate. Results: A total of 32 205 patients were included. A 50% reduction in surgical site infection was achieved after the implementation of two sequential sets of bundles: from 18.16% in the Baseline group to 10.03% with Bundle-1 and 8.19% with Bundle-2. Bundle-2 reduced superficial-surgical site infection (OR 0.74 (95% c.i. 0.58 to 0.95); P = 0.018) and deep-surgical site infection (OR 0.66 (95% c.i. 0.46 to 0.93); P = 0.018) but not organ/space-surgical site infection (OR 0.88 (95% c.i. 0.74 to 1.06); P = 0.172). Compliance increased after the addition of four measures to Bundle-2. In the multivariable analysis, for organ/space-surgical site infection, laparoscopy, oral antibiotic prophylaxis and mechanical bowel preparation were protective factors in colonic procedures, while no protective factors were found in rectal surgery. Duration of stay fell significantly over time, from 7 in the Baseline group to 6 and 5 days for Bundle-1 and Bundle-2 respectively (P < 0.001). The mortality rate fell from 1.4% in the Baseline group to 0.59% and 0.6% for Bundle-1 and Bundle-2 respectively (P < 0.001). There was an increase in Gram-positive bacteria and yeast isolation, and reduction in Gram-negative bacteria and anaerobes in organ/space-surgical site infection. Conclusions: The addition of measures to create a final 10-measure protocol had a cumulative protective effect on reducing surgical site infection. However, organ/space-surgical site infection did not benefit from the addition. No protective measures were found for organ/space-surgical site infection in rectal surgery. Compliance with preventive measures increased from Bundle-1 to Bundle-2.
• dc.format.mimetype application/pdf
• dc.identifier.citation Flores-Yelamos M, Gomila-Grange A, Badia JM, Almendral A, Vázquez A, Parés D, et al. Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study. BJS Open. 2024 Jul 2;8(4):zrae080. DOI: 10.1093/bjsopen/zrae080
• dc.identifier.doi http://dx.doi.org/10.1093/bjsopen/zrae080
• dc.identifier.issn 2474-9842
• dc.identifier.uri http://hdl.handle.net/10230/69832
• dc.language.iso eng
• dc.publisher Oxford University Press
• dc.relation.ispartof BJS Open. 2024 Jul 2;8(4):zrae080
• dc.rights © The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Antibiotic prophylaxis
• dc.subject.keyword Colorectal surgery
• dc.subject.keyword Laparoscopy
• dc.subject.keyword Surgical procedures
• dc.subject.keyword Operative
• dc.subject.keyword Surgical wound infection
• dc.subject.keyword Infections
• dc.subject.keyword Mortality
• dc.subject.keyword Protective factors
• dc.subject.keyword Prevention
• dc.title Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion