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From the JAMA Network |

Care Bundles and Prevention of Surgical Site Infection in Colorectal Surgery

Kamal M. F. Itani, MD1,2
[+] Author Affiliations
1VA Boston Healthcare System, West Roxbury, Massachusetts
2Boston University and Harvard Medical School, Boston, Massachusetts
JAMA. 2015;314(3):289-290. doi:10.1001/jama.2015.4473.
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This From The JAMA Network article discusses a retrospective study published in JAMA Surgery reporting the effect of a preventive care bundle on surgical site infection rates and costs in colorectal surgery.

JAMA Surgery

The Preventive Surgical Site Infection Bundle in Colorectal Surgery: An Effective Approach to Surgical Site Infection Reduction and Health Care Cost Savings

Jeffrey E. Keenan, MD; Paul J. Speicher, MD; Julie K. M. Thacker, MD; Monica Walter, DNP; Maragatha Kuchibhatla, PhD; Christopher R. Mantyh, MD

Importance Surgical site infections (SSIs) in colorectal surgery are associated with increased morbidity and health care costs.

Objective To determine the effect of a preventive SSI bundle (hereafter bundle) on SSI rates and costs in colorectal surgery.

Design Retrospective study of institutional clinical and cost data. The study period was January 1, 2008, to December 31, 2012, and outcomes were assessed and compared before and after implementation of the bundle on July 1, 2011.

Setting and Participants Academic tertiary referral center among 559 patients who underwent major elective colorectal surgery.

Main Outcomes and Measures The primary outcome was the rate of superficial SSIs before and after implementation of the bundle. Secondary outcomes included deep SSIs, organ-space SSIs, wound disruption, postoperative sepsis, length of stay, 30-day readmission, and variable direct costs of the index admission.

Results Of 559 patients in the study, 346 (61.9%) and 213 (38.1%) underwent their operation before and after implementation of the bundle, respectively. Groups were matched on their propensity to be treated with the bundle to account for significant differences in the preimplementation and postimplementation characteristics. Comparison of the matched groups revealed that implementation of the bundle was associated with reduced superficial SSIs (19.3% vs 5.7%, P < .001) and postoperative sepsis (8.5% vs 2.4%, P = .009). No significant difference was observed in deep SSIs, organ-space SSIs, wound disruption, length of stay, 30-day readmission, or variable direct costs between the matched groups. However, in a subgroup analysis of the postbundle period, superficial SSI occurrence was associated with a 35.5% increase in variable direct costs ($13 253 vs $9779, P = .001) and a 71.7% increase in length of stay (7.9 vs 4.6 days, P < .001).

Conclusions and Relevance The preventive SSI bundle was associated with a substantial reduction in SSIs after colorectal surgery. The increased costs associated with SSIs support that the bundle represents an effective approach to reduce health care costs.

JAMA Surg. 2014;149(10):1045-1052. doi:10.1001/jamasurg.2014.346

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