Perioperative surgical care bundle reduces pancreaticoduodenectomy wound infections.
BACKGROUND
Pancreaticoduodenectomy (PD) is a complex surgical procedure with a historically high morbidity rate. The goal of this study was to determine if the implementation of a 12-measure perioperative surgical care bundle (SCB) was successful in reducing infectious and other complications in patients undergoing PD compared with a routine preoperative preparation group (RPP).


METHODS
In this retrospective cohort study utilizing the HPB surgery database at the Thomas Jefferson University, we analyzed clinical data from 233 consecutive PDs from October 2005 to May 2008 on patients who underwent RPP, and compared them with 233 consecutive PDs from May 2008 to May 2010 following the implementation of the SCB. The SCB was the product of multidisciplinary discussion and extensive literature review.


RESULTS
The RPP group and the SCB group had similar demographic characteristics. The overall rate of postoperative morbidity was similar between groups (42.1% versus 37.8%). However, wound infections were significantly lower in the SCB group (15.0% versus 7.7%, P = 0.01).The rates of other common complications, as well as postoperative hospital length of stay, readmissions, and 30-d postoperative mortality were similar between groups.


CONCLUSIONS
The implementation of a SCB was followed by a significant decline in wound infection in patients undergoing PD.
Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary and Related Cancer Center, Philadelphia, Pennsylvania 19107, USA. harish.lavu@jefferson.edu
Harish
H
Lavu
Matthew J
MJ
Klinge
Leonard J
LJ
Nowcid
Herbert E
HE
Cohn
Dane R
DR
Grenda
Patricia K
PK
Sauter
Benjamin E
BE
Leiby
Sean P
SP
Croker
Eugene P
EP
Kennedy
Charles J
CJ
Yeo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult