Key result
Implementation of a pre- and postoperative pulmonary care bundle reduced the incidence of postoperative pneumonia from 0.8% to 0% (P=0) in noncardiac surgical patients.
Why the study?
Postoperative pneumonia increases morbidity and readmissions, and while perioperative chlorhexidine gluconate is supported in cardiac surgery, its efficacy via an oral care bundle in noncardiac surgical patients required evaluation.
Does a pre- and postoperative pulmonary care bundle reduce postoperative pneumonia in noncardiac surgical patients undergoing general anesthesia?
Observational
No
Does a pre- and postoperative pulmonary care bundle reduce postoperative pneumonia in noncardiac surgical patients undergoing general anesthesia?
Absolute Event Rate: 0% vs 0.8%
p-value: p=0
Implementation of a resident-driven pre- and postoperative pulmonary care bundle significantly decreased the rate of postoperative pneumonia in noncardiac surgical patients.
May support pulmonary bundles to lower pneumonia risk; hypothesis-generating pending randomized confirmation in noncardiac surgery.
Postoperative pneumonia increases morbidity, length of stay, and hospital readmission rates. Current data support the use of perioperative chlorhexidine gluconate in elective cardiac surgery patients to prevent postoperative pneumonia. The objectives of this study were to implement a resident-driven quality improvement project and determine the efficacy of an oral care bundle in preventing postoperative pneumonia among noncardiac surgical patients. A retrospective review of postoperative pneumonia occurrences at our hospital captured by the NSQIP database from 2014 to 2016 was conducted. A pre- and postoperative pulmonary care bundle was implemented in all surgical patients undergoing general anesthesia and outcomes were tracked by NSQIP for up to 90 days postoperatively for calendar year 2017. The NSQIP-reported incidence of postoperative pneumonia at our hospital was reduced from 0.8 to 0 per cent (P = 0). The risk-adjusted smoothed rate fell from 1.17 (95% confidence interval 0.77–1.66) in 2014 to 0.33 (95% confidence interval 0.03–0.98) in 2017. We encountered multiple systematic issues while conducting this study, which led to an imbalanced compliance to the preoperative (90%) and postoperative (31%) bundle; however, there was no significant difference between these two groups. Successful implementation of a resident-driven quality project resulted in a decreased rate of postoperative pneumonia.
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Caparelli et al. (2019) conducted an observational in postoperative pneumonia in noncardiac surgical patients. pre- and postoperative pulmonary care bundle vs. historical cohort (2014-2016) was evaluated on postoperative pneumonia (p=0). Implementation of a pre- and postoperative pulmonary care bundle reduced the incidence of postoperative pneumonia from 0.8% to 0% (P=0) in noncardiac surgical patients.
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