title: The preventive surgical site infection bundle in patients with colorectal perforation.
abstract: BACKGROUND
  Incisional surgical site infection (SSI) is one of the most frequent complications that occur after colorectal surgery. Surgery for colorectal perforation carries an especially high risk of incisional SSI because fecal ascites contaminates the incision intraoperatively, and in patients who underwent stoma creation, the incision is located near the infective origin and is subject to infection postoperatively. Although effectiveness of the preventive SSI bundle of elective colorectal surgery has been reported, no study has focused exclusively on emergency surgery for colorectal perforation.
  
  
  METHODS
  Patients with colorectal perforation who underwent emergency surgery and stoma creation from 2010 to 2015 at our center were consecutively enrolled in the study. In March 2013, we developed the preventive incisional SSI bundle for patients with colorectal perforation undergoing stoma creation. The effectiveness of the bundle in these patients was determined and the rates of incisional SSI between before and after March 2013 were compared.
  
  
  RESULTS
  We enrolled 108 patients with colorectal perforation who underwent emergency operation during the study period. Thirteen patients were excluded because they died within 30 days after surgery, and 23 patients without stoma were excluded; thus, 72 patients were analyzed. There were 47 patients in the pre-implementation group and 25 patients in the post-implementation group. The rate of incisional SSI was significantly lower after implementation of preventive incisional SSI bundle (43% vs. 20%, p = 0.049). Postoperative hospital stay was significantly shorter after implementation of the bundle (27 vs. 18 days respectively; p = 0.008).
  
  
  CONCLUSIONS
  The preventive incisional SSI bundle was effective in preventing incisional SSI in patients with colorectal perforation undergoing emergency surgery with stoma creation.
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. tkht26@me.com.|Department of Gastroenterological Surgery and Oncology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ogimachi, Kita-ku, Osaka, Japan. tkht26@me.com.
authors.forename: Takehito
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Clinical Epidemiology, Hyogo College of Medicine, 1 Mukogawa, Nishinomiya, Hyogo, Japan. m@hyo-med.ac.jp.|Clinical Research Center, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. m@hyo-med.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. yubohemian810@yahoo.co.jp.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Kita
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. as_mas_muscle@yahoo.co.jp.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Masui
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. iromitsuk@hotmail.co.jp.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. uu-saka@kcho.jp.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. azuyuki0822@kcho.jp.
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Okada
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. unjikomori@yahoo.co.jp.
authors.forename: Junji
authors.initials: J
authors.lastname: Komori
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. kira-miki@kcho.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Miki
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. ond0303@kcho.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Kondo
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. ryuhara@kcho.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Uryuhara
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. iro64151@kcho.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. ashida@kcho.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hashida
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. aihara@kcho.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaihara
authors.affiliation: Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, Japan. oso@kcho.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Hosotani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D003108:Colonic Diseases / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control*; D013536:Suture Techniques; D007507:Therapeutic Irrigation; D014014:Tissue Adhesives / Q000627:therapeutic use
chemical_list: D014014:Tissue Adhesives