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Reduction of Surgical Site Infections in Patients Undergoing Radical Cystectomy Following Implementation of a Standardized Perioperative Protocol
Kamal Nagpal, MD PhD, John A. Libertino, MD, Robert Duncan, MD, Andrea Sorcini, MD, Ali Minzadeh, MD, David Canes, MD, Karim Hamawy, MD, Jason R. Gee, MD.
Lahey Clinic, Burlington, MA, USA.
Introduction: Patients undergoing radical cystectomy have comorbidities predisposing them to higher risk for post-operative complications which leads to increased use of healthcare resources. Recent NSQIP (American College of Surgeons National Surgical Quality Improvement Program) data has revealed significantly fewer surgical site infections (SSI) at our institution as compared to national outcomes with radical cystectomy. The aim of the study was to assess whether implementation of the Surgical Care Improvement Project (SCIP) may have had an impact in our contemporary experience.
Methods: From January 2002 to present, 664 patients underwent cystectomy at our institution, of which 493 (73.9%) procedures occurred prior to implementation of a standardized perioperative protocol per SCIP guidelines (including chlorhexidine prep) in October 2010. Post-operative wound infection and abscess events were determined from our cystectomy database and hospital-acquired data in comparing earlier versus later cystectomy groups.
Results: NSQIP data from January 2011 to June 2012 revealed a significantly lower rate of SSI events for our institution as compared to national data (5.5% vs 12.3%, p=0.03). Prior to implementation of a standardized perioperative protocol for radical cystectomy patients in October 2010, 28/493 (5.7%) experienced an SSI event as compared to 3/171 (1.8%) patients from October 2010 to February 2013, representing a significant reduction in wound-related infections (p=0.03).
Conclusions: In patients undergoing radical cystectomy at our institution, a significant reduction in surgically-related infections appears temporally related to implementation of a standardized perioperative protocol. Favorable comparison of SSI rates with NSQIP outcomes suggests this may be a successful strategy to reduce morbidity due to SSI events.
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