Enhanced recovery programs and surgical site infections: additive or distinct?

This is the authors' abstract. We don't add key points for this paper.

Background Surgical site infections (SSIs) impact patients and healthcare systems. Predictors of SSIs are well-studied at the patient and procedure-level; the effect of Enhanced Recovery Programs (ERPs) on SSIs is less clear. We aimed to characterize SSI rates and the effects of ERP implementation in a diverse colorectal surgical population at our institution. Methods Patient characteristics and operative factors were reviewed for colorectal surgery patients using single institution American College of Surgeons National Surgical Quality Improvement Program (2011-2021). Patients were compared by surgical timing pre-ERP (2011-2014) and post-ERP (2015-2021) implementation. The primary outcome was SSI 30-days post-operatively. Multivariable and classification tree analyses assessed the association of ERP with SSI rates. Results Of 3349 colorectal surgical patients, SSI rate was 10.6%. There were 46.7% male patients, 72.8% White, with median (IQR) age 57.3 (45.5-67.6). There were 657 patients (19.6%) pre-ERP and 2692 patients (80.4%) post-ERP implementation. SSI rate did not vary by ERP status. Multivariable and classification tree analyses showed association between duration of surgery and SSI rate. Conclusion This study identified higher prevalence of SSIs in colorectal and surgical oncology patients. In colorectal surgery patients, ERP implementation was not associated with decreased SSI rates suggesting a need for SSI-specific interventions when implementing ERPs.