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Standardized perioperative care reduces colorectal surgical site infection in children: A Western Pediatric Surgery
Joseph Tobias1, Benjamin E Padilla2, Justin Lee2
1Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States.
Insights
Implementing a standardized perioperative care bundle significantly reduced surgical site infections (SSI) in pediatric colorectal surgery patients. This protocolized approach offers a promising strategy for improving outcomes and reducing morbidity in this vulnerable population.
Area of Science:
- Pediatric Surgery
- Infectious Disease Control
- Healthcare Quality Improvement
Background:
- Surgical site infection (SSI) is a major complication in pediatric colorectal surgery, leading to increased patient morbidity and healthcare costs.
- Existing protocols for perioperative care in pediatric colorectal surgery are varied, necessitating standardized approaches to mitigate risks.
Purpose of the Study:
- To evaluate the effectiveness of a protocolized perioperative care bundle, termed the "colon bundle," in reducing the incidence of superficial SSI in pediatric patients undergoing colorectal surgery.
- To assess the impact of high versus low compliance with the colon bundle on SSI rates and other clinical outcomes.
Main Methods:
- A prospective cohort study involving 336 pediatric patients (≤18 years) across ten US children's hospitals.
- Patients were categorized into low (1-4 elements) or high (5-8 elements) compliance groups based on adherence to an eight-element perioperative care protocol.
- The primary outcome was the incidence of superficial SSI at 30 days post-surgery, with comparisons made between compliance groups.
Main Results:
- High compliance with the colon bundle was associated with a significantly lower incidence of superficial SSI (4%) compared to low compliance (9.7%, p=0.036).
- No significant differences were observed in postoperative length of stay, readmission rates, reoperation rates, intra-abdominal abscess, or anastomotic leak requiring operation between the groups.
- Individual elements of the colon bundle did not show independent protective effects against superficial SSI.
Conclusions:
- Standardization of perioperative care through a protocolized bundle is effective in reducing superficial SSI in pediatric colorectal surgery.
- Wider implementation of standardized care protocols for pediatric colorectal surgery patients holds potential for improving surgical outcomes and decreasing perioperative morbidity.
Purpose:
Surgical site infection (SSI) remains a significant source of patient morbidity and resource utilization in children undergoing colorectal surgery. We examined the utility of a protocolized perioperative care bundle in reducing SSI in pediatric patients undergoing colorectal surgery.
Methods:
We conducted a prospective cohort study of patients ≤18 years of age undergoing colorectal surgery at ten United States children's hospitals. Using a perioperative care protocol comprising eight elements, or "colon bundle", we divided patients into low (1-4 elements) or high (5-8 elements) compliance cohorts. Procedures involving colorectal repair or anastomosis with abdominal closure were included. Demographics and clinical outcomes were compared between low and high compliance cohorts. Compliance was compared with a retrospective cohort. The primary outcome was superficial SSI incidence at 30 days.
Results:
Three hundred and thirty-six patients were included in our analysis: 138 from the low compliance cohort and 198 from the high compliance cohort. Age and gender were similar between groups. Preoperative diagnosis was similar except for more patients in the high compliance cohort having inflammatory bowel disease (18.2% versus 5.8%, p<0.01). The most common procedure performed was small bowel to colorectal anastomosis. Wound classification and procedure acuity were similar between groups. Superficial SSI at 30 days occurred less frequently among the high compliance compared to the low compliance cohort (4% versus 9.7%, p = 0.036). Median postoperative length of stay and 30-day rates of readmission, reoperation, intra-abdominal abscess and anastomotic leak requiring operation were not significantly different between groups. None of the individual colon bundle elements were independently protective against superficial SSI.
Conclusion:
Standardization of perioperative care is associated with a reduction in superficial SSI in pediatric colorectal surgery. Expansion of standardized protocols for children undergoing colorectal surgery may improve outcomes and decrease perioperative morbidity.
Type Of Study:
Clinical Research Paper LEVEL OF EVIDENCE: Level II.
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