title: Perioperative Bundle Decreases Postoperative Hepatic Surgery Infections.
abstract: BACKGROUND
  Postoperative infections are a costly and morbid complication. The introduction of perioperative infection prevention bundles have decreased surgical site infections (SSIs) in patients undergoing colorectal and pancreatic surgery.
  
  
  OBJECTIVE
  The purpose of this study was to determine if the implementation of a perioperative bundle would reduce postoperative infectious complications in patients undergoing hepatic surgery.
  
  
  METHODS
  An evidence-based, low cost, perioperative infection bundle was created, and a retrospective review of a prospectively maintained database was performed on 163 consecutive patients undergoing hepatic surgery. Patient characteristics, operative details, outcomes, and complications were reviewed, and differences pre- and post-bundle were assessed with univariate and multivariate analyses.
  
  
  RESULTS
  A total of 113 patients received standard infection prophylaxis, while 50 received the perioperative bundle. Twenty-five patients had infections (16 deep abscesses, 3 superficial SSIs, 4 urinary tract infections, 1 pneumonia, 1 bacteremia). The overall infection rate decreased from 20.4 % (23/133) pre-bundle to 4 % (2/50) post-bundle. The SSI rate also decreased from 15 % (17/113) to 4 % (2/50). Univariate analysis showed that institution of the bundle was associated with a lower overall infection rate (p = 0.008), lower SSI rate (p = 0.06), and lower overall complication rate (p = 0.04). Multivariate analysis confirmed that the use of the bundle was independently associated with a lower infection (p = 0.008) and SSI (p = 0.05) rate. The primary length of stay (LOS) and LOS for 60 days postoperatively both significantly decreased post-bundle (from median of 5-4 days, p ≤ 0.001; 6-4 days, p ≤ 0.001).
  
  
  CONCLUSIONS
  Implementation of a perioperative infection prevention bundle significantly decreased overall infections, SSIs, and postoperative LOS in patients undergoing hepatic surgery.
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. Maureen.v.hill@hitchcock.org.
authors.forename: Maureen V
authors.initials: MV
authors.lastname: Hill
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Holubar
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Catherine I
authors.initials: CI
authors.lastname: Garfield Legare
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Luurtsema
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Barth
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents