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Perioperative surgical care bundle reduces pancreaticoduodenectomy wound infections
Harish Lavu1, Matthew J Klinge, Leonard J Nowcid
1Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Cancer Center, Philadelphia, Pennsylvania 19107, USA. harish.lavu@jefferson.edu
Insights
Implementing a surgical care bundle (SCB) significantly reduced wound infections in patients undergoing pancreaticoduodenectomy (PD), a complex surgery. This improvement was observed without increasing other complications or mortality rates.
Area of Science:
- Hepatobiliary and Pancreatic Surgery
- Surgical Quality Improvement
- Perioperative Care
Background:
- Pancreaticoduodenectomy (PD) is associated with high morbidity.
- Previous approaches relied on routine preoperative preparation (RPP).
Purpose of the Study:
- To evaluate the effectiveness of a 12-measure perioperative surgical care bundle (SCB) in reducing complications after PD.
- To compare outcomes between patients receiving SCB and those receiving RPP.
Main Methods:
- Retrospective cohort study using the HPB surgery database.
- Analysis of 233 PD cases with RPP (2005-2008) and 233 PD cases with SCB (2008-2010).
Main Results:
- Overall postoperative morbidity rates were similar between the RPP and SCB groups (42.1% vs. 37.8%).
- Wound infections were significantly lower in the SCB group (15.0% vs. 7.7%, P=0.01).
- Other complications, length of stay, readmissions, and 30-day mortality were comparable between groups.
Conclusions:
- The implementation of a surgical care bundle (SCB) led to a significant reduction in wound infections following pancreaticoduodenectomy (PD).
- SCB represents an effective strategy for improving surgical site infection rates in PD patients.
Background:
Pancreaticoduodenectomy (PD) is a complex surgical procedure with a historically high morbidity rate. The goal of this study was to determine if the implementation of a 12-measure perioperative surgical care bundle (SCB) was successful in reducing infectious and other complications in patients undergoing PD compared with a routine preoperative preparation group (RPP).
Methods:
In this retrospective cohort study utilizing the HPB surgery database at the Thomas Jefferson University, we analyzed clinical data from 233 consecutive PDs from October 2005 to May 2008 on patients who underwent RPP, and compared them with 233 consecutive PDs from May 2008 to May 2010 following the implementation of the SCB. The SCB was the product of multidisciplinary discussion and extensive literature review.
Results:
The RPP group and the SCB group had similar demographic characteristics. The overall rate of postoperative morbidity was similar between groups (42.1% versus 37.8%). However, wound infections were significantly lower in the SCB group (15.0% versus 7.7%, P = 0.01).The rates of other common complications, as well as postoperative hospital length of stay, readmissions, and 30-d postoperative mortality were similar between groups.
Conclusions:
The implementation of a SCB was followed by a significant decline in wound infection in patients undergoing PD.
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