High Compliance With Surgical Site Infection (SSI) Prevention Bundle Reduces Incisional SSI After Colorectal Surgery

Purpose: This study aimed to evaluate association between compliance with surgical site infection (SSI) prevention bundle and the development of superficial or deep incisional SSI following colorectal surgery and to evaluate the impact of incisional SSI on surgical outcomes. Methods: A prospectively collected database of consecutive patients undergoing elective colectomy and/or proctectomy from 2011 to 2019 in a university hospital was reviewed. The association between compliance with Thailand's SSI Prevention Bundle (10 level-1A interventions) and the incidence of incisional SSI was determined. Surgical outcomes were compared between those with incisional SSI and those without. Results: This study included 600 patients with a median age of 64 years (range, 18-102 years). Some 126 patients (21.0%) had stoma formation and 52 (8.7%) underwent laparoscopy. The incidence of incisional SSI was 5.5% (n= 33; 32 superficial incisional SSI and 1 deep incisional SSI). Higher compliance with care bundle tended to decrease incisional SSI (P=0.20). In multivariate analysis, compliance of 70% or more was the only dependent factor for reducing incisional SSI (odds ratio, 0.39; 95% confidence interval, 0.15 to 0.99; P=0.047). None of individual interventions were significantly associated with a lower probability of incisional SSI. Compared with counterparts, patients with incisional SSI had a 2-day longer length of postoperative stay (6 day vs. 4 day, P< 0.001) but comparable time for gastrointestinal recovery and similar rate of 30-day mortality or readmission. Conclusion: High compliance with SSI prevention bundle (especially >= 70%) reduced incisional SSI after colorectal surgery.