The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

• Published in: Journal of clinical medicine 2020-12, Vol.9 (12), p.4006
• Main Authors: Lustenberger, Thomas, Meier, Simon Lars, Verboket, René Danilo, Störmann, Philipp, Janko, Maren, Frank, Johannes, Marzi, Ingo
• Format: Article
• Language: English
• Subjects: Antibiotics; Clinical medicine; Disease prevention; Hospitals; Iodine; Joint surgery; Medical errors; Patient safety; Staphylococcus infections; Statistical analysis; Surgical outcomes; Surgical site infections; Trauma; Trauma centers; Urinary tract diseases; Urinary tract infections; Urogenital system
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm9124006

Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications ( = 40, 24.8% of all surgical complications), followed by screw malposition ( = 20, 12.4%), postoperative dislocations of arthroplasties ( = 18, 11.2%), and suboptimal fracture reduction ( = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.