Effect of a surgical care bundle on the incidence of surgical site infection in hip arthroplasty: a quasi-experimental study.

INTRODUCTION: Surgical site infections (SSI) remain a major source of complications following hip arthroplasty. The aim was to evaluate the effect of a surgical care bundle on the incidence of SSI in hip arthroplasty. METHODS: We conducted a quasi-experimental before-after intervention study following the implementation of a surgical care bundle in 2011. Consecutive patients were selected from surgical scheduling lists and divided into two periods: pre-intervention (2008-2011) and post-intervention (2012-2019). SSI incidence was assessed after a 90-day postoperative surveillance period. The effect of the intervention was evaluated using adjusted odds ratios (OR). RESULTS: A total of 2,044 patients were included, 57.1% of whom were women. 58 SSI were identified. The incidence of SSI decreased from 3.6% in the pre-intervention period to 2.6% in the post-intervention period without reaching statistical significance (OR = 0.70; 95% CI: 0.40-1.22; P = 0.206). Urgent surgery (OR = 2.45; 95% CI: 1.44-4.15; P = 0.001) and NHSN risk categories 2 (OR = 3.63; 95% CI: 1.71-7.72; P = 0.001) and 3 (OR = 14.61; 95% CI: 2.86-74.78; P = 0.001) were associated with a significantly higher risk of SSI. CONCLUSION: Implementation of a surgical care bundle reduced the incidence of SSI, although the reduction did not reach statistical significance. Urgent surgery and higher NHSN risk scores were associated with increased SSI risk. Length of hospital stay was reduced in the post-intervention period.