ISSN: 0034-8376
eISSN: 2564-8896






Effect of a Surgical Care Bundle on the Incidence of Surgical Site Infection in Colorectal Surgery: A Quasi-Experimental Intervention



Leire Zarain-Obrador, Department of Surgery, Rey Juan Carlos Hospital, Móstoles, Madrid, Spain
Marcos Alonso-García, Department of Preventive Medicine, Alcorcón Foundation University Hospital, Alcorcón, Madrid; Department of Medical Specialties and Public Health, Rey Juan Carlos University, Alcorcón, Madrid; Spain
Pablo Gil-Yonte, Department of Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain
Ana I. Hijas-Gómez, Health Technology Assessment Agency (AETS), Madrid, Spain
Diego Rodríguez-Villar, Department of Medical Specialties and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
Brezo Martínez-Amores, Department of Medical Specialties and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
Ángel Gil-de-Miguel, Department of Medical Specialties and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
Jaime Ruiz-Tovar, Department of Surgery, Rey Juan Carlos Hospital, Móstoles, Madrid; Department of Medical Specialties and Public Health, Rey Juan Carlos University, Alcorcón, Madrid; Spain
Gil Rodríguez-Caravaca, Department of Preventive Medicine and Public Health, Hospital Universitario Fundación Alcorcón y Department of Medicine, Surgery, Preventive Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
Manuel Durán-Poveda, Department of General and Digestive Tract Surgery, Rey Juan Carlos University Hospital, Móstoles, Madrid; Department of Medicine and Surgery, School of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain


Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention’s effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.



Keywords: Surgical site infection. Incidence. Care bundle. Colorectal surgery.