Reducing Surgical Site Infections in the Enhanced Recovery After Surgery Patient Population

Abstract

BACKGROUND Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based practice (EBP) inter-professional approach to improving care for the surgical patient. ERAS pathways include minimally invasive surgeries, pre-op nutritional support, intraoperative fluid management, and decreased opioid use with early mobilization, introduction of food, and gum chewing. Patient engagement is critical to achieving ERAS objectives. European countries have been implementing the concepts associated with ERAS for nearly 20?years. Benefits of ERAS innovative pathways are decreased length of stay, postop complications, infections, malnutrition, pain management and hospital readmission. METHODS Surgical site infections (SSIs) are associated with an increased length of stay, morbidity, costs of care, and readmissions. An ERAS program was started at a large acute care, level II trauma facility in January 2017 to utilize evidence-based interventions to improve patient outcomes in elective colorectal surgery patients. RESULTS From 1st to 4th Quarter 2017, there was a steady decrease in the surgical site infection rate in ERAS colon procedures from 6% to 2%. While a slight increase was noted in the first two quarters of 2018, the overall Colon SSI Standardized Infection Ration (SIR) dropped from 1.867 in the 1st Quarter of 2017 to 0.656 in the 2nd Quarter of 2018. CONCLUSIONS The ERAS program improved the outcomes of patients requiring a colon procedure by improving pain control and return of gastric motility and reducing SSI and length of hospital stay. Interventions that may have contributed to the reduced colon SSI SIR include changes in practice by colon surgeons (separate closure trays, oral antibiotics, separate staplers e.g.) and implementation of an evidenced-based ERAS program.