Implementation of a surgical site infection prevention bundle in gynecologic oncology patients: An enhanced recovery after surgery initiative

Maede Ejaredar; Shannon M Ruzycki; Tali Sara Glazer; Pat Trudeau; Brent Jim; Gregg Nelson; Anna Cameron

doi:10.1016/j.ygyno.2024.02.023

Implementation of a surgical site infection prevention bundle in gynecologic oncology patients: An enhanced recovery after surgery initiative

Gynecol Oncol. 2024 Mar 1:185:173-179. doi: 10.1016/j.ygyno.2024.02.023. Online ahead of print.

Authors

Maede Ejaredar¹, Shannon M Ruzycki², Tali Sara Glazer¹, Pat Trudeau³, Brent Jim⁴, Gregg Nelson⁵, Anna Cameron⁶

Affiliations

¹ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Surgery Strategic Clinical Network TM, Alberta Health Services, Edmonton, Alberta, Canada.
⁴ Department of Oncology & Department of Obstetrics and Gynecology, University of Saskatchewan, Regina, Saskatchewan, Canada.
⁵ Department of Oncology and Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁶ Department of Oncology and Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: Anna.Cameron@albertahealthservices.ca.

PMID: 38430815
DOI: 10.1016/j.ygyno.2024.02.023

Abstract

Objective: To evaluate the clinical outcomes pre- and post-implementation of an evidence-informed surgical site infection prevention bundle (SSIPB) in gynecologic oncology patients within an Enhanced Recovery After Surgery (ERAS) care pathway.

Methods: Patients undergoing laparotomy for a gynecologic oncology surgery between January-June 2017 (pre-SSIPB) and between January 2018-December 2020 (post-SSIPB) were compared using t-tests and chi-square. Patient characteristics, surgical factors, and ERAS process measures and outcomes were abstracted from the ERAS® Interactive Audit System (EIAS). The primary outcomes were incidence of surgical site infections (SSI) during post-operative hospital admission and at 30-days post-surgery. Secondary outcomes included total postoperative infections, length of stay, and any surgical complications. Multivariate models were used to adjust for potential confounding factors.

Results: Patient and surgical characteristics were similar in the pre- and post-implementation periods. Evaluation of implementation suggested that preoperative and intraoperative components of the intervention were most consistently used. Infectious complications within 30 days of surgery decreased from 42.1% to 24.4% after implementation of the SSIPB (p < 0.001), including reductions in wound infections (17.0% to 10.8%, p = 0.02), urinary tract infections (UTI) (12.7% to 4.5%, p < 0.001), and intra-abdominal abscesses (5.4% to 2.5%, p = 0.05). These reductions were associated with a decrease in median length of stay from 3 to 2 days (p = 0.001). In multivariate analysis, these SSI reductions remained statistically significant after adjustment for potential confounders.

Conclusion: Implementation of SSIPB was associated with a reduction in SSIs and infectious complications, as well as a shorter length of stay in gynecologic oncology patients.

Keywords: Gynecologic oncology; Infection rates; Length of stay; Quality improvement; Surgical site infection prevention bundles.