Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients.
BACKGROUND
Care bundles are a strategy that can be used to reduce the risk of surgical site infection (SSI), but individual studies of care bundles report conflicting outcomes. This study assesses the effectiveness of care bundles to reduce SSI among patients undergoing colorectal surgery.


METHODS
We performed a systematic review and meta-analysis of randomized controlled trials, quasi-experimental studies, and cohort studies of care bundles to reduce SSI. The search strategy included database and clinical trials register searches from 2012 until June 2014, searching reference lists of retrieved studies and contacting study authors to obtain missing data. The Downs and Black checklist was used to assess the quality of all studies. Raw data were used to calculate pooled relative risk (RR) estimates using Cochrane Review Manager. The I(2) statistic and funnel plots were performed to identify publication bias. Sensitivity analysis was carried out to examine the influence of individual data sets on pooled RRs.


RESULTS
Sixteen studies were included in the analysis, with 13 providing sufficient data for a meta-analysis. Most study bundles included core interventions such as antibiotic administration, appropriate hair removal, glycemic control, and normothermia. The SSI rate in the bundle group was 7.0% (328/4,649) compared with 15.1% (585/3,866) in a standard care group. The pooled effect of 13 studies with a total sample of 8,515 patients shows that surgical care bundles have a clinically important impact on reducing the risk of SSI compared to standard care with a CI of 0.55 (0.39-0.77; P = .0005).


CONCLUSIONS
The systematic review and meta-analysis documents that use of an evidence-based, surgical care bundle in patients undergoing colorectal surgery significantly reduced the risk of SSI.
School of Health Sciences, University of Nottingham, Nottingham, UK. Electronic address: judith.tanner@nottingham.ac.uk.
Judith
J
Tanner
Faculty of Health and Life Sciences, De Montfort University, Leicester, UK.
Wendy
W
Padley
Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK.
Ojan
O
Assadian
Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK.
David
D
Leaper
Richard Wells Research Centre, University of West London, London, UK.
Martin
M
Kiernan
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Charles
C
Edmiston
D003082:Colectomy / Q000009:adverse effects*; D003106:Colon / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D006801:Humans; D064872:Patient Care Bundles; D016032:Randomized Controlled Trials as Topic; D012007:Rectum / Q000601:surgery; D012306:Risk; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology