Background: Postoperative infections are a costly and morbid complication. The introduction of perioperative infection prevention bundles have decreased surgical site infections (SSIs) in patients undergoing colorectal and pancreatic surgery.
Aim: The purpose of this study was to determine if the implementation of a perioperative bundle would reduce postoperative infectious complications in patients undergoing hepatic surgery.
Methods: An evidence-based, low cost, perioperative infection bundle was created, and a retrospective review of a prospectively maintained database was performed on 163 consecutive patients undergoing hepatic surgery. Patient characteristics, operative details, outcomes, and complications were reviewed, and differences pre- and post-bundle were assessed with univariate and multivariate analyses.
Results: A total of 113 patients received standard infection prophylaxis, while 50 received the perioperative bundle. Twenty-five patients had infections (16 deep abscesses, 3 superficial SSIs, 4 urinary tract infections, 1 pneumonia, 1 bacteremia). The overall infection rate decreased from 20.4 % (23/133) pre-bundle to 4 % (2/50) post-bundle. The SSI rate also decreased from 15 % (17/113) to 4 % (2/50). Univariate analysis showed that institution of the bundle was associated with a lower overall infection rate (p = 0.008), lower SSI rate (p = 0.06), and lower overall complication rate (p = 0.04). Multivariate analysis confirmed that the use of the bundle was independently associated with a lower infection (p = 0.008) and SSI (p = 0.05) rate. The primary length of stay (LOS) and LOS for 60 days postoperatively both significantly decreased post-bundle (from median of 5-4 days, p ≤ 0.001; 6-4 days, p ≤ 0.001).
Conclusions: Implementation of a perioperative infection prevention bundle significantly decreased overall infections, SSIs, and postoperative LOS in patients undergoing hepatic surgery.