Evidence map›Paper›PMID 30077525›Full record

ArticleHPB : the official journal of the International Hepato Pancreato Biliary Association2019

A perioperative multidisciplinary care bundle reduces surgical site infections in patients undergoing synchronous colorectal and liver resection.

Lauren S Tufts, Emma D Jarnagin, Jessica R Flynn, Mithat Gonen, Jose G Guillem, Philip B Paty, Garrett M Nash, Joshua J Smith, Iris H Wei, Emmanouil Pappou and 8 more

Abstract read
In one paragraph

Article in HPB : the official journal of the International Hepato Pancreato Biliary Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Lauren S TuftsDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Emma D JarnaginDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Jessica R FlynnDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Mithat GonenDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Jose G GuillemDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Philip B PatyDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Garrett M NashDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Joshua J SmithDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Iris H WeiDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Emmanouil PappouDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Michael I D'AngelicaDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Peter J AllenDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
T Peter KinghamDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Vinod P BalachandranDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Jeffrey A DrebinDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Julio Garcia-AguilarDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
William R JarnaginDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Martin R WeiserDepartment of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA. Electronic address: weiser1@mskcc.org.

Funding

X-RAY CRYSTALLOGRAPHYP30CA008748 · NCI · SLOAN-KETTERING INSTITUTE FOR CANCER RES · PI Nicholas D Socci · 1985 to 2026
$347.4M
NCI NIH HHS P30 CA008748
6 · The paper itself

Abstract

backgroundSurgical site infections (SSIs) are a major cause of morbidity, mortality, and healthcare costs, and patients undergoing simultaneous colorectal/liver resections are at an especially high SSI risk.

methodsData were collected on all patients undergoing synchronous colorectal/liver resection from 2011 to 2016 (n = 424). The intervention, implemented in 2013, included 13 multidisciplinary perioperative components. The primary endpoints were superficial/deep and organ space SSIs. Secondary endpoints were hospital length of stay (LOS) and 30-day readmission rate. To control for changes in SSI rates independent of the intervention, interrupted time series analysis was conducted.

resultsOverall, superficial/deep, and organ space SSIs decreased by 60.5% (p < 0.001), 80.6% (p < 0.001), and 47.6% (p = 0.008), respectively. In the pre-intervention cohort (n = 231), there were 79 (34.2%), 31 (13.4%), and 48 (20.8%) total, superficial/deep, and organs space SSIs, respectively. In the post-intervention cohort (n = 193), there were 26 (13.5%), 5 (2.6%), and 21 (10.9%) total, superficial/deep, and organs space SSIs, respectively. Median LOS decreased from 9 to 8 days (p < 0.001). Readmission rates did not change (p = 0.6). Interrupted time series analysis found no significant trends in SSI rate within the pre-intervention (p = 0.35) and post-intervention (p = 0.55) periods.

conclusionIn combined colorectal/liver resection patients, implementation of a multidisciplinary care bundle was associated with a 61% reduction in SSIs, with the greatest impact on superficial/deep SSI, and modest reduction in LOS. The absence of trends within each time period indicated that the intervention was likely responsible for SSI reduction. Future efforts should target further reduction in organ space SSI.

Indexed as

Patient Care BundlesPatient Care TeamPerioperative CareAdultAgedAged, 80 and overColectomyCombined Modality TherapyDatabases, FactualFemaleHepatectomyHumansInterdisciplinary CommunicationLength of StayMaleMiddle Aged

Identifiers

PMID30077525
PMCPMC6358518

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.