title: The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings.
abstract: OBJECTIVE
  Surgical site infections (SSIs) in colorectal surgery are associated with increased morbidity and health care costs.
  
  
  OBJECTIVE
  To determine the effect of a preventive SSI bundle (hereafter bundle) on SSI rates and costs in colorectal surgery.
  
  
  METHODS
  Retrospective study of institutional clinical and cost data. The study period was January 1, 2008, to December 31, 2012, and outcomes were assessed and compared before and after implementation of the bundle on July 1, 2011.
  
  
  METHODS
  Academic tertiary referral center among 559 patients who underwent major elective colorectal surgery.
  
  
  METHODS
  The primary outcome was the rate of superficial SSIs before and after implementation of the bundle. Secondary outcomes included deep SSIs, organ-space SSIs, wound disruption, postoperative sepsis, length of stay, 30-day readmission, and variable direct costs of the index admission.
  
  
  RESULTS
  Of 559 patients in the study, 346 (61.9%) and 213 (38.1%) underwent their operation before and after implementation of the bundle, respectively. Groups were matched on their propensity to be treated with the bundle to account for significant differences in the preimplementation and postimplementation characteristics. Comparison of the matched groups revealed that implementation of the bundle was associated with reduced superficial SSIs (19.3% vs 5.7%, P < .001) and postoperative sepsis (8.5% vs 2.4%, P = .009). No significant difference was observed in deep SSIs, organ-space SSIs, wound disruption, length of stay, 30-day readmission, or variable direct costs between the matched groups. However, in a subgroup analysis of the postbundle period, superficial SSI occurrence was associated with a 35.5% increase in variable direct costs ($13,253 vs $9779, P = .001) and a 71.7% increase in length of stay (7.9 vs 4.6 days, P < .001).
  
  
  CONCLUSIONS
  The preventive SSI bundle was associated with a substantial reduction in SSIs after colorectal surgery. The increased costs associated with SSIs support that the bundle represents an effective approach to reduce health care costs.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Keenan
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Julie K M
authors.initials: JK
authors.lastname: Thacker
authors.affiliation: Performance Services, Duke University Health System, Durham, North Carolina.
authors.forename: Monica
authors.initials: M
authors.lastname: Walter
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Maragatha
authors.initials: M
authors.lastname: Kuchibhatla
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
mesh_terms: D000368:Aged; D003107:Colorectal Surgery; D017046:Cost Savings; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010043:Outcome and Process Assessment, Health Care; D057216:Propensity Score; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics* / Q000517:prevention & control*