Preventing Postoperative Sepsis: Multidisciplinary Implementation of Diverse Countermeasures in our first NSQIP Project

Abstract

Using data from the National Surgical Quality Improvement Project (NSQIP), we aimed to reduce the incidence of postoperative sepsis, focusing on patients receiving red blood cell (RBC) transfusions and with open wounds. We postulated that diverse countermeasures would reduce postoperative sepsis. Workgroups were created around 4 problems with root causes identified using standardized processes: excessive RBC transfusions, owing to transfusing for Hb > 7 or > 1 unit at a time; infrequent use of cell salvage due to knowledge deficit or cell salvage machine not available; incorrect antibiotics owing to penicillin-allergic patients not getting cephalosporins or patients getting empiric antibiotics to which organisms are resistant; suboptimal postoperative wound management owing to poor communication regarding care plans and care transitions. Thirteen countermeasures were implemented. With improvement in 7 of 8 process metrics, the rate of postoperative sepsis declined from 1.56% (tenth decile performance in the NSQIP database) to 0.59% (first decile), P = 0.0065.

Keywords: National Surgical Quality Improvement Project; Quality improvement; open wound; postoperative sepsis; red blood cell transfusion.