Association between Patient and Hospital Characteristics and Adherence to a Surgical Site Infection Reduction Bundle in a Statewide Surgical Quality Improvement Collaborative

被引:3
作者
Brajcich, Brian C. [1 ,2 ]
Schlick, Cary Jo R. [1 ,2 ]
Halverson, Amy L. [1 ,2 ]
Huang, Reiping [1 ,2 ]
Yang, Anthony D. [1 ,2 ]
Love, Remi [1 ,2 ]
Bilimoria, Karl Y. [1 ,2 ]
McGee, Michael F. [1 ,2 ]
机构
[1] Northwestern Med, Dept Surg, Surg Outcomes & Qual Improvement Ctr SOQIC, 633 N St Clair St,20-038, Chicago, IL 60611 USA
[2] Illinois Surg Qual Improvement Collaborat ISQIC, Chicago, IL USA
关键词
COLORECTAL SURGERY; OF-CARE; PROGRAM; IMPACT; COST; RISK;
D O I
10.1097/XCS.0000000000000110
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Adherence to bundled interventions can reduce surgical site infection (SSI) rates; however, predictors of successful implementation are poorly characterized. We studied the association of patient and hospital characteristics with adherence to a colorectal SSI reduction bundle across a statewide surgical collaborative. STUDY DESIGN: A 16-component colorectal SSI reduction bundle was introduced in 2016 across a statewide quality improvement collaborative. Bundle adherence was measured for patients who underwent colorectal operations at participating institutions. Multivariable mixed-effects logistic regression models were constructed to estimate associations of patient and hospital factors with bundle adherence and quantify sources of variation. RESULTS: Among 2,403 patients at 35 hospitals, a median of 11 of 16 (68.8%, interquartile range 8 to 13) bundle elements were completed. The likelihood of completing 11 or more elements was increased for obese patients (56.8% vs 51.5%, odds ratio [OR] 1.39, 95% CI 1.05 to 1.86, p = 0.022) but reduced for underweight patients (31.0% vs 51.5%, OR 0.51, 95% CI 0.26 to 1.00, p = 0.048) compared with patients with a normal BMI. Lower adherence was noted for patients treated at safety net hospitals (n = 9 hospitals, 24.4% vs 54.4%, OR 0.08, 95% CI 0.01 to 0.44, p = 0.004). The largest proportion of adherence variation was attributable to hospital factors for six bundle elements, surgeon factors for no elements, and patient factors for nine elements. CONCLUSION: Adherence to an SSI reduction bundle is associated with patient BMI and hospital safety net status. Quality improvement groups should consider institutional traits for optimal implementation of SSI bundles. Safety net hospitals may require additional focus to overcome unique implementation barriers. (C) 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.
引用
收藏
页码:783 / 792
页数:10
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