Ten-year-long implementation of a bundle for the prevention of surgical site infections: A cohort study of the temporal trend and factors influencing compliance

Abstract

Background

Many bundles have proven effective at preventing surgical site infections (SSIs), but little is known about factors influencing compliance to such bundles.

Methods

This cohort study includes 41,400 surgeries performed in 47 hospitals throughout a decade. The outcome of interest was binary compliance with a 4-element bundle for SSI prevention. A multivariable logistic regression model was computed with 12 predictor variables: patient sex, age, American Society of Anesthesiologists score, surgical specialty, length of preoperative stay, procedure year, procedure duration, surgical technique, presence of a prosthetic implant, elective versus emergent procedure, hospital type, and hospital size.

Results

Bundle compliance has increased significantly since its implementation, reaching 67.1% in the latest year. Lower odds of bundle compliance are correlated with emergent procedures (OR 0.3697), procedure duration above the first tertile (0.8597), age above the first quartile (0.7365), absence of a prosthetic implant, open surgical technique, and preoperative stay above 1 day (0.7920).

Discussion

Older age, longer procedure duration, longer preoperative stay, and an open surgical technique all correlate negatively with bundle compliance and are also known risk factors for SSIs.

Conclusions

Certain patient subgroups are at higher risk for bundle noncompliance, and thus show greater margins for improvement.