QAPI 23 - Targeting Complex Colorectal Procedures to Reduce Organ Space Surgical Site Infections in Oncology Patients

Background: Surgical site infections (SSI) following colorectal procedures are a common complication and potentially preventable cause of morbidity and mortality. In 2021, the SSI rate for colon procedures was flagged as high by the state department of health at a tertiary cancer center. Simultaneously, an upward trend was identified in organ space SSIs. After discussions with surgery leadership, further analysis was conducted to determine possible points for intervention.

Methods: Procedures occurring between 2018-2019 and 2021, were categorized into groups based on the ICD10 procedure performed and surgical services involved. Procedures were categorized as Group 1, a colorectal surgeon (CoSx) performing a colon/rectal (CR) procedure only; Group 2, CoSx performing multiple procedures including a CR procedure; Group 3, CoSx plus another surgical service performing multiple procedures including a CR surgery; and Group 4, a non-CoSx performing a CR procedure. Using the National Healthcare Safety Network (NHSN) definitions, raw SSI rates were calculated for these 4 groups.

Results: Approximately 30% of colorectal surgeries are performed by the colorectal service with another surgical service, with half of those procedures being a joint colon and liver procedure. Organ space SSI rates for Group 1 remained steady from 2018-2021, at 3.6% and 3.7% respectively. The SSI rate for Group 2 increased from 4.2% in 2018 to 7.2% in 2019 but decreased to 4.7% in 2021. The SSI rate for Group 3 increased from 3.6% to 7.3% from 2018-2021 and for Group 4, from 2.9% in 2018 to 6.1% in 2021.

Conclusions: Colorectal surgery in oncology patients poses unique challenges as patients with disseminated disease can require extensive surgeries requiring partnerships between surgical services. Understanding these trends has opened the door for discussions on interventions targeting patients undergoing a joint procedure and the expansion of service-specific interventions, such as surgical care bundles, to other surgical services.