Standardized perioperative care reduces colorectal surgical site infection (SSI) in children | 10 United States children's hospitals | Prospective cohort study | Patients ≤18 years of age undergoing colorectal surgery | 336 patients | Peri-op care protocol (8 elements) | 138 pt Low Compliance (1-4 elements) | 198 pt High Compliance (5-8 elements)* | Age, gender, pre-op diagnosis were similar between groups. | *In high compliance cohort more patients had inflammatory bowel disease (18.2% vs 5.8%, p<0.01) | The most common procedure | small bowel to colorectal anastomosis | The primary outcome | superficial SSI incidence at 30 days | High compliance << low compliance cohort (4% vs 9.7%, p = 0.036) | Median post-op length of stay | 30-day rates of readmission | Intra-abdominal abscess | Reoperation | were not significantly different between groups | Conclusion: | Expansion of standardized peri-op care protocols is associated with a reduction in superficial SSI in pediatric colorectal surgery and it may decrease peri-op morbidity. | https://doi.org/10.1016/j.jpedsurg.2022.09.026 | Source: Tobias J et.al. | Oregon Health and Science University, Doernbecher Children's Hospital, Portland, OR, United States | @StayCurrentMD | @EmTombash | Cincinnati Children's | Journal of Pediatric Surgery
Standardized perioperative care reduces colorectal surgical site infection in children: A Western Pediatric Surgery Research Consortium multicenter analysis
Infographic · May 2023 · 1 min read
In brief
In brief
Multi-center prospective study demonstrates that standardized eight-element perioperative care bundles significantly reduce superficial surgical site infections in pediatric colorectal surgery (high compliance group 4% vs. low compliance 9.7%). Protocol adherence is key to achieving improved infection outcomes without affecting length of stay or other complications.
- High compliance (5-8 elements) with standardized perioperative care bundle reduced superficial SSI from 9.7% to 4% in pediatric colorectal surgery
- No single bundle element was independently protective—the combined protocol approach drove SSI reduction across 10 US children's hospitals
- Standardized care did not significantly affect length of stay, readmission, reoperation, abscess, or anastomotic leak rates at 30 days
- 336 patients ≤18 years undergoing colorectal repair/anastomosis showed benefit from protocolized care regardless of wound class or acuity
- Multicenter adoption of perioperative care bundles may reduce SSI morbidity in pediatric colorectal surgery without added resource burden
Written by the GCMD Library team from the infographic.
The infographic uses a teal, white, and yellow color scheme with illustrated icons of a hospital building and a patient receiving care. Data is presented in distinct sections with arrows connecting key findings. A stylized intestine illustration appears in the lower right. The layout flows from study design at top, through methodology in middle, to outcomes and conclusion at bottom.
Joseph Tobias, Benjamin E. Padilla, Justin Lee, Stephanie Chen, Kasper S. Wang, Lorraine I. Kelley-Quon, Claudia Mueller, Stephen B. Shew, Katie Joskowitz, Romeo C. Ignacio Jr., Lauren L. Evans, Aaron R. Jensen, Shannon N. Acker, Andrew Mason, Alicia Johnson, Jessica McConahey, Erik Hansen, Samir R. Pandya, Scott S. Short, Katie W. Russell, Lauren Nicassio, Caitlin A. Smith, Elizabeth Fialkowski
Purpose: Surgical site infection (SSI) remains a significant source of patient morbidity and resource utilization in children undergoing colorectal surgery. We examined the utility of a protocolized perioperative care bundle in reducing SSI in pediatric patients undergoing colorectal surgery.
Methods: We conducted a prospective cohort study of patients ≤18 years of age undergoing colorectal surgery at ten United States children's hospitals. Using a perioperative care protocol comprising eight elements, or “colon bundle”, we divided patients into low (1–4 elements) or high (5–8 elements) compliance cohorts. Procedures involving colorectal repair or anastomosis with abdominal closure were included. Demographics and clinical outcomes were compared between low and high compliance cohorts. Compliance was compared with a retrospective cohort. The primary outcome was superficial SSI incidence at 30 days.
Results: Three hundred and thirty-six patients were included in our analysis: 138 from the low compliance cohort and 198 from the high compliance cohort. Age and gender were similar between groups. Preoperative diagnosis was similar except for more patients in the high compliance cohort having inflammatory bowel disease (18.2% versus 5.8%, p<0.01). The most common procedure performed was small bowel to colorectal anastomosis. Wound classification and procedure acuity were similar between groups. Superficial SSI at 30 days occurred less frequently among the high compliance compared to the low compliance cohort (4% versus 9.7%, p = 0.036). Median postoperative length of stay and 30-day rates of readmission, reoperation, intra-abdominal abscess and anastomotic leak requiring operation were not significantly different between groups. None of the individual colon bundle elements were independently protective against superficial SSI.
Conclusion: Standardization of perioperative care is associated with a reduction in superficial SSI in pediatric colorectal surgery. Expansion of standardized protocols for children undergoing colorectal surgery may improve outcomes and decrease perioperative morbidity.