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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; Padley, Wendy; Assadian, Ojan; Leaper, David; Kiernan, Martin; Edmiston, Charles E.

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 Thumbnail


Authors

JUDITH TANNER Judith.Tanner@nottingham.ac.uk
Professor in Adult Nursing

Wendy Padley

Ojan Assadian

David Leaper

Martin Kiernan

Charles E. Edmiston



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.

Journal Article Type Article
Acceptance Date Mar 3, 2015
Online Publication Date Apr 24, 2015
Publication Date Jul 1, 2015
Deposit Date Jul 29, 2016
Publicly Available Date Jul 29, 2016
Journal Surgery
Print ISSN 0039-6060
Electronic ISSN 1532-7361
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 158
Issue 1
DOI https://doi.org/10.1016/j.surg.2015.03.009
Keywords Surgical Site Infection, Colorectal Surgery, Care Bundle, Systematic Review
Public URL https://nottingham-repository.worktribe.com/output/983184
Publisher URL http://www.sciencedirect.com/science/article/pii/S0039606015001713

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