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Peri-operative Bundle Reduces Post-operative Hepatic Surgery Infections
*Maureen V Hill, *Stefan David Holubar, *Catherine I Garfield Legare, *Christopher M Luurtsema, Richard J. Barth Jr.
Dartmouth Hitchcock Medical Center, Lebanon, NH

Objective
Post-operative infections are a costly and morbid complication. The introduction of infection reducing bundles has decreased surgical site infections in patients undergoing colorectal and pancreatic surgery; however, it is unknown if applying a bundle would reduce the infection rate in hepatic surgery. The purpose of this study was to determine if the implementation of a peri-operative bundle would reduce post-operative infectious complications in patients undergoing hepatic surgery.
Design
Retrospective review of a prospective database.
Setting
Academic medical center.
Patients
146 consecutive patients undergoing hepatic surgery; 113 received standard infection prophylaxis and 33 received the peri-operative bundle.
Intervention
An evidence-based, low cost, peri-operative infection prevention bundle was implemented in December 2012. This consisted of a standard antibiotic with intra-operative re-dosing, chlorhexadine prep, ioban drape, and intra-peritoneal antibiotic wash.
Main outcome measures
Surgical site infections (SSI), all infections, and inpatient hospital days from post-op day 0-60.
Results
There were 23 patients with infections, 14 of which were deep abscesses, 3 superficial wound infections, 4 UTIs, 1 pneumonia, and 1 bacteremia. The SSI rate decreased from 15% (17/113) to 3% (1/33) in patients receiving the peri-operative bundle. The overall infection rate decreased from 20% (23/133) to 3 % (1/33). In multivariate analysis, institution of the bundle was associated with lower SSI (p=0.04) and overall infection rates (p=0.01). Mean inpatient hospital days decreased from 7.1 to 4.6 (p=<0.001).
Conclusions
Implementation of a peri-operative infection prevention bundle significantly decreased post-operative surgical site infections, total infections, and inpatient hospital days in patients undergoing hepatic surgery.


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