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

Tanner, Judith and Padley, Wendy and Assadian, Ojan and Leaper, David and Kiernan, Martin and Edmiston, Charles E. (2015) 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. Surgery, 158 (1). pp. 66-77. ISSN 1532-7361

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Abstract

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, quasiexperimental 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 I2 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 metaanalysis. 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).

Conclusion. 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.

Item Type: Article
Keywords: Surgical Site Infection, Colorectal Surgery, Care Bundle, Systematic Review
Schools/Departments: University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Health Sciences
Identification Number: https://doi.org/10.1016/j.surg.2015.03.009
Depositing User: Tanner, Judith
Date Deposited: 29 Jul 2016 09:10
Last Modified: 18 Sep 2016 08:25
URI: http://eprints.nottingham.ac.uk/id/eprint/35226

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