• Jeffrey E Keenan, Paul J Speicher, Julie K M Thacker, Monica Walter, Maragatha Kuchibhatla, and Christopher R Mantyh.
• Department of Surgery, Duke University Medical Center, Durham, North Carolina.
• JAMA Surg. 2014 Oct 1;149(10):1045-52.

ImportanceSurgical site infections (SSIs) in colorectal surgery are associated with increased morbidity and health care costs.ObjectiveTo determine the effect of a preventive SSI bundle (hereafter bundle) on SSI rates and costs in colorectal surgery.DesignRetrospective 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.Setting And ParticipantsAcademic tertiary referral center among 559 patients who underwent major elective colorectal surgery.Main Outcomes And MeasuresThe 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.ResultsOf 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 And RelevanceThe 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.

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