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Surgical Site Infections During the Pandemic: The Impact of the “COVID Bundle”

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Abstract

Background

A reduction in surgical site infections (SSIs) has been reported in several discrete patient populations during the COVID-19 pandemic. Herein, this study evaluates the impact of the COVID-19 pandemic on SSI in a large patient cohort incorporating multiple surgical disciplines. We hypothesize that enhanced infection control and heightened awareness of such measures is analogous to an SSI care bundle, the hypothetical “COVID bundle”, and may impact SSI rates.

Method

Data collected for the American College of Surgeons National Surgical Quality Improvement Program between January 1, 2015, and April 1, 2021, were retrospectively analyzed. SSI rates were compared among time-dependent patient cohorts: Cohort A (pre-pandemic, N = 24,060, 87%) and Cohort B (pandemic, N = 3698, 13%). Time series and multivariable analyses predicted pre-pandemic and pandemic SSI trends and tested for association with timing of surgery.

Results

The overall SSI incidence was reduced in Cohort B versus Cohort A (2.8% vs. 4.5%, p < 0.001). Multivariable analysis indicated a downward SSI trend before pandemic onset (IRR 0.997, 95% CI 0.994, 1). At pandemic onset, the trend reduced by a relative factor of 39% (IRR 0.601, 95% CI 0.338, 1.069). SSI then trended upward during the pandemic (IRR 1.035, 95% CI 0.965, 1.111). SSI rates significantly trended downward in general surgical patients at pandemic onset (IRR 0.572, 95% CI 0.353, 0.928).

Conclusion

Although overall SSI incidence was reduced during the pandemic, a statistically significant decrease in the predicted SSI rate only occurred in general surgical patients at pandemic onset. This trend may suggest a positive impact of the “COVID bundle” on SSI rates in these patients.

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Data availability

Study data are available on request.

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Acknowledgements

The authors would like the thank the ACS-NSQIP data collectors at University Health Network, April Krikke, Areej Waqar, Sandy Lu, Syeda Hossain, Laavanyah Vigneswaran, and Rona Sales, for their assistance with data collection for this study. No preregistration exists for the reported studies reported in this article.

Funding

No funding sources to declare.

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Authors and Affiliations

  1. Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada

    Louise Catherine McLoughlin, Nathan Perlis, Katherine Lajkosz & Girish S. Kulkarni

  2. Department of Urology, St. James’s Hospital, Dublin 8, Ireland

    Louise Catherine McLoughlin

  3. Department of Surgery, Trinity College Dublin, Dublin, Ireland

    Louise Catherine McLoughlin

  4. Department of Surgery, University Health Network, University of Toronto, Toronto, Canada

    Alexandra Boasie & Timothy Jackson

  5. Department of Anesthesiology and Pain Management, University Health Network, University of Toronto, Toronto, Canada

    Tariq Esmail

  6. Department of Quality, Safety and Clinical Adoption, University of Toronto, Toronto, Canada

    Chantelle Nielson & Natalia Lavrencic

Authors
  1. Louise Catherine McLoughlin
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Contributions

The motivation and need for the study were conceived and developed by LCM, TJ, and GSK. LCM, KL, and GSK developed the study design. LCM and NL performed the literature search and data collection. KL performed the statistical analysis. Data interpretation was performed by LCM and GSK in consultation with NP, AB, TE, CN, NL, and TJ. LCM and GSK drafted the manuscript. Critical editing of the manuscript was performed by NP, AB, TE, CN, NL, and TJ.

Corresponding author

Correspondence to Louise Catherine McLoughlin.

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Conflict of interest

Several authors (NL, AB, TE, CN, TJ, NP) are part of the Quality, Safety & Clinical Adoption program at the University Health Network and are working on reducing surgical site infections at the institution. There are no conflicts of interest to declare.

Ethical approval

This study protocol was reviewed by the University Health Network ethics committee and received institutional review board approval, Study ID: 20-5913.

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McLoughlin, L.C., Perlis, N., Lajkosz, K. et al. Surgical Site Infections During the Pandemic: The Impact of the “COVID Bundle”. World J Surg 47, 2310–2318 (2023). https://doi.org/10.1007/s00268-023-07112-3

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  • DOI: https://doi.org/10.1007/s00268-023-07112-3

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