Reduction of surgical site infection rates in elective colorectal surgery by means of a nationwide interventional surveillance programme. A cohort study

Abstract

Introduction

Colorectal surgery has the highest surgical site infection (SSI) rates of all abdominal surgeries. Epidemiological surveillance is an excellent instrument to reduce SSI rates, but its effects may be time-limited and need to be monitored periodically. This study analyses the effectiveness of an interventional surveillance programme with regard to reducing SSI rates after elective colorectal surgery.

Methods

Cohort study analysing a SSI surveillance programme in elective colorectal surgery over a 15-year period. Prospectively collected data were stratified by 5-year periods (Periods 1, 2 and 3), and SSI rates, length of stay, readmission, mortality and microbiological aetiology were investigated.

Results

A total of 64,074 operations were included (42,665 colon surgery and 21,409 rectal surgery). Overall SSI incidence in colon surgery fell from 19.6% in Period 1 to 7.6% in Period 3 (rho = −0.961). Organ-space SSI (O/S-SSI) was 8.3% in Period 1 and 4.7% in Period 3 (rho = −0.815). In rectal surgery, overall SSI fell from 20.6% to 12.8% (rho = −0.839), and O/S-SSI from 8.5% to 8.3%, the latter difference being non-significant. The intervention that achieved the greatest SSI reduction was a preventive bundle comprising six measures. Hospital stay and mortality rates decreased, while SSIs after discharge and readmissions increased. An increase in Gram-positive cocci and fungi, and reductions in Gram-negative bacteria and anaerobes were detected for both incisional and O/S-SSI.

Conclusions

Detailed analysis of SSI rates allows the design of strategies for reducing their incidence. An interventional surveillance programme was effective in decreasing SSI rates in colorectal surgery.