Using a Data Driven Improvement Methodology to Decrease Surgical Site Infections in a Community Neurosurgery Practice: Optimizing Preoperative Screening and Perioperative Antibiotics.

Abstract

OBJECTIVE\nWe employed a data driven methodology to decrease the departmental surgical site infection (SSI) rate to a goal of 1%.\n\n\nMETHODS\nA prospective interventional study with historical controls comparing pre-implementation/intervention (unknown MSSA/MRSA status and standard weight and drug allergy based preoperative antibiotics) to post-implementation/intervention (optimized pre-operative chlorhexidine showers, MSSA/MRSA screening, MSSA/MRSA decolonization, and optimized preoperative antibiotic order set implementation). The American College of Surgeons National Surgical Quality Improvement Program was used for case surveillance. The primary outcome was the presence of a surgical site infection with a secondary outcome of cost(s) of implementation.\n\n\nRESULTS\n317 NSQIP abstracted neurosurgical cases were analyzed, 163 cases pre-implementation and 154 cases post-implementation. There were no significant differences between the pre- and post-implementation cohorts with regards to patient demographics and baseline comorbidities with the exceptions of inpatient and functional status (p < 0.001). The most common procedures were lumbar decompression (31%), lumbar discectomy (27%), and ACDF (10.4%). Post-implementation, 30 patients were MSSA positive (20%) and 4 MRSA positive (2.6%). 30 patients received preoperative intranasal mupirocin decolonization (88%), and 4 patients received adjusted preoperative antibiotics (12%). Following protocol implementation, the SSI rate decreased from 6.7% (OR 2.82) to 0.96% (OR 0.91). The cost of implementation was $27,179 or $58 per patient.\n\n\nCONCLUSIONS\nThe findings highlight the importance of systematically investigating areas of gap in existing clinical practice and quality improvement projects to increase patient safety and enhance the value of care delivered to neurosurgical patients.