Preventing Postoperative Sepsis: Multidisciplinary Implementation of Diverse Countermeasures in our first NSQIP...

Area of Science:

• Surgical Quality Improvement
• Infectious Disease Prevention
• Patient Safety

Background:

• Postoperative sepsis poses a significant risk, particularly for patients undergoing procedures involving red blood cell (RBC) transfusions and open wounds.
• The National Surgical Quality Improvement Project (NSQIP) database provides valuable data for analyzing and improving surgical outcomes.
• Identifying root causes of sepsis is crucial for developing effective prevention strategies.

Purpose of the Study:

• To reduce the incidence of postoperative sepsis in a specific patient cohort.
• To investigate the effectiveness of diverse countermeasures targeting key risk factors.
• To improve performance metrics related to transfusion practices, cell salvage, antibiotic use, and wound management.

Main Methods:

• Utilized NSQIP data to identify patients at high risk for postoperative sepsis.
• Established workgroups to address identified root causes: excessive RBC transfusions, limited cell salvage use, inappropriate antibiotic selection, and suboptimal wound care.
• Implemented 13 distinct countermeasures based on root cause analysis.

Main Results:

• Achieved improvement in 7 out of 8 process metrics targeted by the interventions.
• Demonstrated a significant reduction in the rate of postoperative sepsis from 1.56% to 0.59%.
• The sepsis rate decreased from the tenth decile to the first decile of NSQIP performance.

Conclusions:

• The implemented countermeasures were effective in reducing the incidence of postoperative sepsis.
• Multifaceted interventions addressing transfusion, antibiotic, and wound management practices can significantly improve patient safety.
• The study provides a model for quality improvement initiatives aimed at preventing surgical site infections and sepsis.