Multidisciplinary, perioperative care bundle decreases surgical site infection in patients undergoing synchronous colorectal/liver resection

Background: Surgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs. Patients undergoing synchronous colorectal/liver resection are at especially high risk. This study measures the effects of a multidisciplinary, SSI reduction project in metastatic colorectal cancer patients undergoing synchronous colorectal/liver resection. Methods: Consecutive patients undergoing synchronous colorectal/liver resections at Memorial Sloan Kettering Cancer Center from 2011 to 2016 (n = 424) were included in the study. The intervention, implemented on Nov 1, 2013, included 13 total preoperative, intraoperative, and postoperative care components. The primary endpoint was SSI (both superficial/deep and organ space). Secondary endpoints were hospital length of stay (LOS) and 30-day readmission rate. Analysis was performed with Wilcoxon Rank Sum and Fisher’s Exact tests and multivariate logistic regression. Results: Overall, superficial/deep, and organ space SSI decreased by 60.5% (34.2% v 13.5%, p < 0.001), 80.6% (13.4% v 2.6%, p < 0.001), and 47.6% (20.8% v 10.9%, p < 0.008) after implementing the intervention, respectively (Table). Median LOS decreased from 9 (IQR 4-60) to 8 days (4–48) (p < 0.001), and 30-day readmission rates did not change (18.6% v 20.7%, p = 0.6). Operative duration, smoking, wound classification and implementation of the care bundle (intervention) predicted SSI. Smoking, wound classification and implementation of the care bundle were independently associated with SSI. Conclusion: In patients undergoing combined colorectal/liver resection, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSI and modest reduction in LOS. Rates of all types of SSI improved, but greatest advance was noted in superficial/deep SSI. Future multidisciplinary strategies should target deep organ space infection.TableSummary of primary and secondary study endpointsPre-intervention cohortPost-intervention cohortp valueN231193N/AOverall SSI79 (34.2%)26 (13.5%)<0.001Superficial/deep infection31 (13.4%)5 (2.6%)<0.001Organ space infection48 (20.8%)21 (10.9%)0.008LOS (days, range)9 (4-60)8 (4-48)<.00130 day readmission rate43 (18.6%)40 (20.7%)0.62 Open table in a new tab