Department of Surgery, Emory university school of medicine, Atlanta, US

Background An established quality indicator and predictor of unfavourable patient outcomes is surgical site infection (SSI). Although many methods have been developed to lower SSI, the best procedure is still unknown. The study's objective was to evaluate how established protocol affected SSI following colon surgery. Methods In 2017, we developed a colon SSI bundle that includes a chlorhexidine prescrub followed by chloraPrep, betadine wound wash, irrigation with antibiotics, use of a closure tray, and dressing of the incision with silver-impregnated gauze. All patients receiving elective colon surgery were included in a retrospective study of a 2-y (2016–2017) prospectively collected before and after analysis. Preprotocol (PP: year 2016) and postprotocol (PoP: year 2017) patient groups were created. Using propensity score matching for age, gender, comorbidities, anaesthesia severity score, indication of procedure, and procedure type, patients in the two groups were matched. SSI, hospital length of stay, and readmission rate were used as outcome measures. Results 328 patients in total were evaluated, and 94 patients (PP:47 and PoP:47) were included after propensity matching. 43.6% of patients were men, the average age was 63.7 16.4 years, and 44.6% of surgeries were laparoscopic. Demographics, comorbidities, and specifics of the surgery were the same in both groups. In comparison to PP patients, PoP patients exhibited significantly decreased odds ratios for superficial and deep SSI (odds ratio: 0.91 [0.74-0.98] and 0.97 [0.65-0.99], respectively). In comparison to non-PoP patients, PoP patients had shorter lengths of stay (P = 0.049) and a trend toward lower readmission rates (P = 0.098). PP patients and an 85% decrease in the usual infection rate reported by the Centers for Medicare and Medicaid Services. Conclusions Patient outcomes are improved by protocol-driven patient care. In patients having colon surgery, the SSI bundle decreased the SSI. National SSI bundle creation will improve patient outcomes by standardising care.

Surgical site infection, Colon surgery, Protocol

Catherine Abern. Following colon surgery, a Protocol-Driven Decrease in Surgical Site Infections. Insights Journal of Surgery and Clinical Case Reports 2020.