A Care Bundle to Prevent Surgical Site Infections in Emergency General Surgery: A Prospective Cohort Study

BackgroundSurgical site infections (SSI) are common complications in emergency general surgery (EGS), contributing to morbidity, prolonged hospitalization, and excessive healthcare costs. Bundled care interventions have been shown to reduce SSI rates in elective procedures, but evidence for their effectiveness in EGS remains limited. This study aimed to evaluate the impact of a multifaceted SSI prevention bundle on SSI rates in patients undergoing open EGS.MethodsAfter IRB a prospective before-and-after study at a tertiary referral center between November 2020 and February 2023 was conducted. Consecutive adult patients undergoing open abdominal EGS operations were included. The pre-bundle group received standard care, whereas the intervention group was managed with an 11-point SSI prevention bundle. Centers for Disease Control and Prevention definitions of SSI were used. A doubly robust approach with inverse probability weighting and multivariable regression was deployed to adjust for confounders.ResultsA total of 343 cases were included: 226 in the pre-bundle group and 117 in the bundle group. Adjusted analysis showed statistically significant risk reductions at 48%, 68%, and 55% for superficial, deep, and intra-abdominal infections, respectively. The bundle group had a significantly shorter median length of stay (8 vs. 13 days, p = 0.010), despite a longer operative time. No differences were observed in the Clavien-Dindo grade of the SSI or the proportion of SSIs presenting post-discharge.ConclusionsImplementation of the SSI prevention bundle significantly reduced infection rates and length of hospital stay in patients undergoing EGS. These findings support the adoption of bundled strategies in emergency surgical care.