Standardized perioperative care reduces colorectal surgical site infection in children: A Western Pediatric Surgery Research Consortium multicenter analysis

Authors

Joseph Tobias, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States. Electronic address: tobiasj@ohsu.edu.
Benjamin E. Padilla, Phoenix Children's Hospital, Phoenix, AZ, United States.
Justin Lee, Phoenix Children's Hospital, Phoenix, AZ, United States.
Stephanie Chen, Children's Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA, United States.
Kasper S. Wang, Children's Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA, United States.
Lorraine I. Kelley-Quon, Children's Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA, United States.
Claudia Mueller, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, United States.
Stephen B. Shew, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, United States.
Katie Joskowitz, Rady Children's Hospital, University of California San Diego, San Diego, CA, United States.
Romeo C. Ignacio, Rady Children's Hospital, University of California San Diego, San Diego, CA, United States.
Lauren L. Evans, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States.
Aaron R. Jensen, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States.
Shannon N. Acker, Children's Hospital Colorado, University of Colorado, Aurora, CO, United States.
Andrew Mason, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States.
Alicia Johnson, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States.
Jessica McConahey, University of Texas Southwestern, Dallas, TX, United States.
Erik Hansen, University of Texas Southwestern, Dallas, TX, United States.
Samir R. Pandya, University of Texas Southwestern, Dallas, TX, United States.
Scott S. Short, Primary Children's Hospital, University of Utah, Salt Lake City, UT, United States.
Katie W. Russell, Primary Children's Hospital, University of Utah, Salt Lake City, UT, United States.
Lauren Nicassio, Seattle Children's, University of Washington, Seattle, WA, United States.
Caitlin A. Smith, Seattle Children's, University of Washington, Seattle, WA, United States.
Elizabeth Fialkowski, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, United States.

Document Type

Article

Abstract

PURPOSE: Surgical site infection (SSI) remains a significant source of patient morbidity and resource utilization in children undergoing colorectal surgery. We examined the utility of a protocolized perioperative care bundle in reducing SSI in pediatric patients undergoing colorectal surgery. METHODS: We conducted a prospective cohort study of patients ≤18 years of age undergoing colorectal surgery at ten United States children's hospitals. Using a perioperative care protocol comprising eight elements, or "colon bundle", we divided patients into low (1-4 elements) or high (5-8 elements) compliance cohorts. Procedures involving colorectal repair or anastomosis with abdominal closure were included. Demographics and clinical outcomes were compared between low and high compliance cohorts. Compliance was compared with a retrospective cohort. The primary outcome was superficial SSI incidence at 30 days. RESULTS: Three hundred and thirty-six patients were included in our analysis: 138 from the low compliance cohort and 198 from the high compliance cohort. Age and gender were similar between groups. Preoperative diagnosis was similar except for more patients in the high compliance cohort having inflammatory bowel disease (18.2% versus 5.8%, p<0.01). The most common procedure performed was small bowel to colorectal anastomosis. Wound classification and procedure acuity were similar between groups. Superficial SSI at 30 days occurred less frequently among the high compliance compared to the low compliance cohort (4% versus 9.7%, p = 0.036). Median postoperative length of stay and 30-day rates of readmission, reoperation, intra-abdominal abscess and anastomotic leak requiring operation were not significantly different between groups. None of the individual colon bundle elements were independently protective against superficial SSI. CONCLUSION: Standardization of perioperative care is associated with a reduction in superficial SSI in pediatric colorectal surgery. Expansion of standardized protocols for children undergoing colorectal surgery may improve outcomes and decrease perioperative morbidity. TYPE OF STUDY: Clinical Research Paper LEVEL OF EVIDENCE: Level II.

Medical Subject Headings

Child; Humans; Colorectal Neoplasms (complications, surgery); Perioperative Care (methods); Prospective Studies; Retrospective Studies; Surgical Wound Infection (epidemiology, prevention & control, etiology); Postoperative Complications

Publication Date

1-1-2023

Publication Title

Journal of pediatric surgery

E-ISSN

1531-5037

Volume

58

Issue

1

First Page

45

Last Page

51

PubMed ID

36289033

Digital Object Identifier (DOI)

10.1016/j.jpedsurg.2022.09.026

Recommended Citation

Tobias, Joseph; Padilla, Benjamin E.; Lee, Justin; Chen, Stephanie; Wang, Kasper S.; Kelley-Quon, Lorraine I.; Mueller, Claudia; Shew, Stephen B.; Joskowitz, Katie; Ignacio, Romeo C.; Evans, Lauren L.; Jensen, Aaron R.; Acker, Shannon N.; Mason, Andrew; Johnson, Alicia; McConahey, Jessica; Hansen, Erik; Pandya, Samir R.; Short, Scott S.; Russell, Katie W.; Nicassio, Lauren; Smith, Caitlin A.; and Fialkowski, Elizabeth, "Standardized perioperative care reduces colorectal surgical site infection in children: A Western Pediatric Surgery Research Consortium multicenter analysis" (2023). Neurology. 1493.
https://scholar.barrowneuro.org/neurology/1493