Standardized perioperative care reduces colorectal surgical site infection in children: A Western Pediatric Surgery Research Consortium multicenter

Purpose: Surgical site infection (SSI) remains a significant source of patient morbidity and resource uti-lization in children undergoing colorectal surgery. We examined the utility of a protocolized perioperative care bundle in reducing SSI in pediatric patients undergoing colorectal surgery. Methods: We conducted a prospective cohort study of patients <= 18 years of age undergoing colorectal surgery at ten United States children's hospitals. Using a perioperative care protocol comprising eight ele-ments, or colon bundle, we divided patients into low (1-4 elements) or high (5-8 elements) compliance cohorts. Procedures involving colorectal repair or anastomosis with abdominal closure were included. De-mographics and clinical outcomes were compared between low and high compliance cohorts. Compliance was compared with a retrospective cohort. The primary outcome was superficial SSI incidence at 30 days. Results: Three hundred and thirty-six patients were included in our analysis: 138 from the low com-pliance cohort and 198 from the high compliance cohort. Age and gender were similar between groups. Preoperative diagnosis was similar except for more patients in the high compliance cohort having in-flammatory bowel disease (18.2% versus 5.8%, p < 0.01). The most common procedure performed was small bowel to colorectal anastomosis. Wound classification and procedure acuity were similar between groups. Superficial SSI at 30 days occurred less frequently among the high compliance compared to the low compliance cohort (4% versus 9.7%, p = 0.036). Median postoperative length of stay and 30-day rates of readmission, reoperation, intra-abdominal abscess and anastomotic leak requiring operation were not significantly different between groups. None of the individual colon bundle elements were independently protective against superficial SSI. Conclusion: Standardization of perioperative care is associated with a reduction in superficial SSI in pe-diatric colorectal surgery. Expansion of standardized protocols for children undergoing colorectal surgery may improve outcomes and decrease perioperative morbidity. Type of Study: Clinical Research Paper Level of Evidence: Level II (c) 2022 Elsevier Inc. All rights reserved.