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Session: ePoster: Quality and Cost 1 (Sun8)

EP359 - Outcomes after Surgical Site Infection Prevention Bundle Implementation for Elective Colorectal Surgery

Sunday, May 11, 2025
9:11 AM – 9:16 AM PT
Location: Monitor 9, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Solomon Feuerwerker, MD

    Resident physician
    University of Vermont
    Burlington, Vermont, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • MR

    Monica Raymond, RN, MS, MPH

    Infection Preventionist
    University of Vermont Medical Center
    Burlington, Vermont, United States

    Disclosure information not submitted.

  • SA

    Stas Amato, MD

    General Surgery Resident
    University of Vermont Medical Center
    Burlington, Vermont, United States

    Disclosure information not submitted.

  • SK

    Stacey L. Keith, MD

    Surgeon
    PeaceHealth Southwest
    Ridgefield, Washington, United States

    Disclosure information not submitted.

  • NB

    Nicholas Bedrin, MD

    Assistant Professor of Surgery
    University of Rochester Medical Center
    Rochester, New York, United States

    Disclosure information not submitted.

  • DG

    Diana Grinberg, UVM Department of Surgery

    Research Assistant
    UVMMC
    Everett, Massachusetts, United States

    Disclosure information not submitted.

  • JC

    Jennifer G. Chen, BA, MS

    Medical Student
    University of Vermont Larner College of Medicine
    South Burlington, Vermont, United States

    Disclosure information not submitted.

  • LG

    Linda Gruppi, RN MSN, ASQ CMQ/OE, PMP, CPHQ

    Senior Quality Improvement Partner
    University of Vermont Medical Center
    Hinesburg, Vermont, United States

    Disclosure information not submitted.

  • CN

    Cindy Noyes, MD

    Infectious Disease Attending
    University of Vermont Medical Center
    Burlington, Vermont, United States

    Disclosure information not submitted.

  • PC

    Peter Callas, PhD, MS

    Associate Professor
    University of Vermont
    Burlington, Vermont, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • PC

    Peter Cataldo, MD

    Professor of Surgery
    Larner College of Medicine
    Stowe, Vermont, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Solomon Feuerwerker, MD: This individual has no financial relationships with ineligible companies.
Peter Cataldo, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Surgical Site Infections (SSIs) after colorectal resection are a source of significant morbidity for patients. SSI prevention bundles have been proposed to reduce rates of such infections in the elective setting. We sought to evaluate the impact of implementation of an SSI prevention bundle at our academic medical center.

Methods/Interventions: We performed a retrospective cohort study to compare SSI rates before and after implementing an SSI prevention bundle. The bundle was rolled out in 2016. Data were collected for the pre-bundle period (“pre”), January 2014 to July 2015 and the post-bundle period (“post”), January 2017 to June 2019. The time between the two periods was considered a wash-out phase. The bundle included mechanical bowel prep and pre-op oral antibiotics, preoperative correction of anemia, perioperative warming, use of wound protectors, hyperoxygenation intra- and post-operatively, use of dedicated closing trays, and introduction of fluorescence imaging to assess tissue perfusion of the anastomosis. Inclusion criteria were elective colon or colorectal resections performed on day of admission. Emergent and urgent cases, ileostomy reversals, and radical appendectomies were excluded, as were rectal only resections. Patient data were collected via EMR queries and manual chart review. Univariate statistics were used to characterize differences between groups, multivariable logistic regression was used to examine the association between bundle implementation and SSI rates while controlling for confounding variables.

Results/Outcomes: 501 cases were included in the study: 150 in the pre group and 351 in the post group. Mean age was higher in the post group (61.4 ± 14.7 vs 57.7 ± 14.5, p < 0.05). Gender, BMI, smoking status, diabetes, IBD, and perioperative steroid use were not significantly different between groups. The presence of a cancer diagnosis was higher in the post group (56.7 vs 32%, p < 0.001). ASA status (ASA 3: 32.7 vs 47.0%) and wound class (Class II: 95.3 vs 86.9%) differed significantly between groups. Rates of overall SSI were significantly lower in the post-bundle group (4 vs 10%, p < 0.05), as were rates of intraabdominal SSI (2.6 vs 7.3%, p < 0.05). Rate of incisional SSI trended lower in the post group (1.4 vs 2.7%, p > 0.05) On regression analysis, the bundle was associated with decreased overall SSI (OR: 0.317, 95% CI: 0.134-0.754, p < 0.01) and decreased intraabdominal SSI (OR: 0.286, 95% CI: 0.097-0.845, p < 0.05). Bundle implementation was not associated with a significant trend change for incisional SSI (OR: 0.390, 95% CI: 0.086-1.779, p > 0.05).

Conclusion/Discussion: At our institution, the implementation of an SSI prevention bundle for patients undergoing elective colorectal resection was associated with decreased overall SSI and decreased intraabdominal SSI. There was no clear trend for incisional SSI, with the caveat that the event rate for this outcome was quite low in our study population.