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Ann Surg Oncol. 2015 Dec;22 Suppl 3:S1140-6. doi: 10.1245/s10434-015-4584-2. Epub 2015 May 14.

Perioperative Bundle Decreases Postoperative Hepatic Surgery Infections.

Author information

1
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Maureen.v.hill@hitchcock.org.
2
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

Abstract

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.

PMID:
25971958
DOI:
10.1245/s10434-015-4584-2
[Indexed for MEDLINE]

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