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  • Implementation of an Infection Prevention Bundle and Increased Physician Awareness Improve Surgical Outcomes and Reduce Costs Associated with Spine Surgery: A 10-Year Experience

    Final Number:
    285

    Authors:
    Prateek Agarwal AB; Nitin Agarwal MD; Ashley Querry; Zachary J Tempel MD; Robert Max Friedlander MD; Peter C. Gerszten MD MPH FACS; D. Kojo Hamilton MD; David O. Okonkwo MD, PhD; Adam S. Kanter MD

    Study Design:
    Other

    Subject Category:
    Spine

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit- 2017

    Introduction: Previous studies have demonstrated the efficacy of infection prevention protocols in reducing infection rates. However, there exists a lack of literature on the implementation of infection prevention bundles to reduce SSIs specifically in patients undergoing spine surgery. Furthermore, besides formal infection prevention bundles, the effect of physician awareness interventions on healthcare risks has not been adequately addressed. As such, we investigated the effects of an evolving infection prevention protocol augmented by increased physician awareness on spine surgery infection rates and resultant cost containment.

    Methods: Neurological spine surgeons at a single academic institution were informed of spine surgery infection control measures as well as individual, independently adjudicated, spine surgery infection rates and rankings amongst their institutional peers. The groups were divided into those that actively employed recommended infection control measure protocols, and those that did not.

    Results: With the implementation of postoperative surgical dressing measures and physician awareness, the postoperative spine surgery infection rate decreased by 45% from 3.8% to 2.1% for collaborative neurosurgeons (Risk Ratio = 0.55; 95% CI, 0.32 – 0.93; p = 0.03), resulting in an estimated annual cost savings of $291,000. This reduction in infection rate was not observed for non-collaborative neurosurgeons, though the overall infection rate amongst all neurosurgeons decreased from 3.3% to 1.5% (Risk Ratio = 0.46; 95% CI, 0.28 – 0.73; p = 0.0013). Thus, it appears as if the infection rate reduction amongst collaborative neurosurgeons was driving the reduction in the overall infection rate amongst all neurosurgeons.

    Conclusions: A novel paradigm for spine surgery infection control combined with physician awareness methods resulted in significantly decreased infection rates and associated cost reduction. Thus, information sharing and physician engagement as a supplement to formal infection control measures results in improvements in surgical safety and costs.

    Patient Care: In this manuscript, we examine the effects of a novel paradigm for spine surgery infection control combined with physician awareness methods which resulted in in significantly decreased infection rates and an associated cost reduction. By implementing this evolving model, other institutions may be able to improve patient care and outcomes as well.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of infection prevention bundles to reduce surgical site infections specifically in patients undergoing spine surgery, 2) Discuss, in small groups, the potential for cost savings associated with reduced infection rates, 3) Identify an effective methods to utilize physician awareness to augment infection prevention bundles to reduce surgical site infections.

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