# Standardized perioperative care reduces colorectal surgical site infection in children — GCMD Library

<p>New article you should know! by Dr. Alex Halpern</p>

<p>"Standardized perioperative care reduces colorectal surgical site infection in children: A Western Pediatric Surgery Research Consortium multicenter analysis” <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Joseph Tobias</a> et.al.</p>

<p>Full article: https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext </p>

<p>Authors: <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Joseph Tobias</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Benjamin E. Padilla</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Justin Lee</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Stephanie Chen</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Kasper S. Wang</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Lorraine I. Kelley-Quon</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Claudia Mueller</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Stephen B. Shew</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Katie Joskowitz</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Romeo C. Ignacio Jr.</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Lauren L. Evans</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Aaron R. Jensen</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Shannon N. Acker</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Andrew Mason</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Alicia Johnson</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Jessica McConahey</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Erik Hansen</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Samir R. Pandya</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Scott S. Short</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Katie W. Russell</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Lauren Nicassio</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Caitlin A. Smith</a>, <a href="https://www.jpedsurg.org/article/S0022-3468(22)00624-8/fulltext#">Elizabeth Fialkowski</a></p>

<p>Abstract </p>

<p>Purpose</p>

<p>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.</p>

<p>Methods</p>

<p>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.</p>

<p>Results</p>

<p>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%, <em>p</em><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%, <em>p</em> = 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.</p>

<p>Conclusion</p>

<p>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.</p>

<p>Type of Study</p>

<p>Clinical Research Paper</p>

<p>Level of Evidence</p>

<p>Level II</p>


Type: video · 1 min · posted 2023-04-19
Canonical: https://library.globalcastmd.com/watch/standardized-perioperative-care-reduces-colorectal-surgical-site-infection-in-children-6578

## Chapters
- [0:00](https://library.globalcastmd.com/watch/standardized-perioperative-care-reduces-colorectal-surgical-site-infection-in-children-6578?t=0) Perioperative care bundle for pediatric colorectal SSI reduction

## Statements
- "Surgical site infections are a major cause of perioperative morbidity in children undergoing colorectal surgery" — Alex Halpern (epidemiological) [0:00](https://library.globalcastmd.com/watch/standardized-perioperative-care-reduces-colorectal-surgical-site-infection-in-children-6578?t=0)
- "The Western Pediatric Surgery Research Consortium conducted a prospective cohort study on children undergoing colorectal surgery across 10 hospitals in the US" — Alex Halpern (clinical) [0:20](https://library.globalcastmd.com/watch/standardized-perioperative-care-reduces-colorectal-surgical-site-infection-in-children-6578?t=20)
- "The study utilized an 8-part perioperative care bundle" — Alex Halpern (clinical) [0:32](https://library.globalcastmd.com/watch/standardized-perioperative-care-reduces-colorectal-surgical-site-infection-in-children-6578?t=32)
- "Children were split into either a high or low compliance group based on adherence to the care bundle" — Alex Halpern (clinical) [0:32](https://library.globalcastmd.com/watch/standardized-perioperative-care-reduces-colorectal-surgical-site-infection-in-children-6578?t=32)
- "Children in the high compliance group had a statistically significant decrease in rates of superficial surgical site infection when compared to children in the low compliance group" — Alex Halpern (clinical) [0:41](https://library.globalcastmd.com/watch/standardized-perioperative-care-reduces-colorectal-surgical-site-infection-in-children-6578?t=41)
- "Standardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery" — Alex Halpern (opinion) [0:41](https://library.globalcastmd.com/watch/standardized-perioperative-care-reduces-colorectal-surgical-site-infection-in-children-6578?t=41)

## Transcript
Surgical site infections are a major cause of perioperative morbidity in children undergoing colorectal surgery. Could a protocolized perioperative care bundle reduce these damaging infections? I'm Alex Halpern, general surgery resident from GW working with Cincinnati Children's, and this is an article that you should know. The Western Pediatric Surgery Research Consortium conducted a prospective cohort study on children undergoing colorectal surgery across 10 hospitals in the US. They utilized an 8-part perioperative care bundle and split children into either a high or low compliance group. And what did they find? They found that children in the high compliance group had a statistically significant decrease in rates of superficial surgical site infection when compared to children in the low compliance group, showing that standardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery. Let us know what you think in the comments below.

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Not medical advice · citation policy: https://library.globalcastmd.com/ai