Perioperative Bundle to Reduce Surgical Site Infection after Pancreaticoduodenectomy: A Prospective Cohort Study.

Abstract

BACKGROUND:

Pancreaticoduodenectomy is historically associated with incisional surgical site infection (iSSI) rates between 15% and 20%. Prospective studies have been mixed with respect to the benefit of individual interventions directed at decreasing iSSI. We hypothesized that the application of a perioperative bundle during pancreaticoduodenectomy would decrease the rate of iSSIs significantly.

METHODS:

An initial cohort of 150 consecutive post-pancreaticoduodenectomy patients were assessed within 2 to 4 weeks of operation to determine baseline iSSI rates. The CDC definition of iSSI was used. A 4-part perioperative bundle was then instituted for the second cohort of 150 patients. This bundle consisted of a double-ring wound protector, gown/glove and drape change before fascial closure, irrigation of the wound with bacitracin solution, and a negative-pressure wound dressing that was left in place until postoperative day 7 or day of discharge. Three-hundred patients provided 80% power to detect a 50% risk reduction in iSSIs.

RESULTS:

Cohorts 1 and 2 were similar with respect to age (68 vs 69 years; p = 0.918), sex (male, 51% vs 55%; p = 0.644), BMI (26 vs 26 kg/m2; p = 0.928), use of neoadjuvant therapy (21% vs 17%; p = 0.377), median operative time (222 vs 215 minutes; p = 0.366), and presence of a preoperative stent (53% vs 41%; p = 0.064). The iSSI rate was 22.3% in the initial cohort. This rate was higher than both our institutional database (13%) and NSQIP reporting (11%). Within the second cohort, the iSSI rate decreased significantly to 10.7% (n = 16; p = 0.012). All 4 components of the bundle were used in 91% of cohort 2 patients.

CONCLUSIONS:

In this cohort study of 300 consecutive patients who underwent pancreaticoduodenectomy, the implementation of a 4-part bundle decreased iSSI rate from 22% to 11%.

• Authors: Sharon A Lawrence, Caitlin A McIntyre, Alessandra Pulvirenti, Kenneth Seier, Yuting Chou, Mithat Gonen, Vinod P Balachandran, T Peter Kingham, Michael I D'Angelica, Jeffrey A Drebin, William R Jarnagin, Peter J Allen
• Journal: Journal of the American College of Surgeons (J Am Coll Surg) Vol. 228 Issue 4 Pg. 595-601 (04 2019) ISSN: 1879-1190 [Electronic] United States
• PMID: 30630087 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Combined Modality Therapy
• Female
• Humans
• Infection Control (methods)
• Logistic Models
• Male
• Middle Aged
• Pancreaticoduodenectomy
• Patient Care Bundles (methods)
• Prospective Studies
• Surgical Wound Infection (epidemiology, prevention & control)
• Treatment Outcome