Preventing Surgical Site Infections in Bypass Patients in the Era of Hospital-Based Quality Improvement Initiatives

Abstract

The purpose of the study was to investigate risk factors associated with surgical site infections (SSIs) in vascular patients postbypass surgery in the context of a hospital-based quality improvement initiative. A retrospective study was conducted using a combination of National Surgical Quality Improvement Program (NSQIP) data and medical record review. Bypass surgery patients from October 2013 to December 2014 were included. Demographic data along with preoperative, intraoperative, and postoperative clinical data were collected from 68 patients within the timeline. Forty-three of 60 variables (72%) were available through NSQIP, and the remainder were supplemented with record review. Twenty-nine of 68 patients (42.6%) presented with SSI. All demographics in 29 patients with SSI were compared with the other 39 patients without SSI. In addition, environmental factors (operating room traffic) and compliance with proper use of antibiotics, antibiotic redosing, postoperative glucose control, normothermia, postoperative mobility, and wound care were measured. The result of the review revealed no demographic relationship between the groups with SSI and without SSI. However, a combination of Surgical Care Improvement Project (SCIP) measures and environmental factors were discovered to be potential contributors of SSIs in our patient population. Variables most highly correlated with SSI were average blood glucose of >11 mmol on postoperative day 1 to 3, postoperative mobilization, normothermia, and high operating room traffic during the operation. All variables highly correlated with infection were added by record review, and were not available in NSQIP. NSQIP was effective to identify cases with infections through basic demographic and clinical information. Record review was required to add variables that allowed identification of patients at high risk of infection. Our study suggests improvement of postoperative blood glucose, reduction in operating room traffic, and mobilization may lower postoperative SSI.