The DNP Project: Literature Synthesis
“For adult patients, on a medical-surgical unit, does implementation of the Enhanced Recovery After Surgery (ERAS) protocol, as compared to current practice, impact surgical site infection (SSI) rates in 8-10 weeks?”
A surgical site infection is ” an infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure or within 90 days if a prosthetic material is implanted at surgery” (U.S. Department of Health and Human Services, 2019). In the United States, surgical site infections affect as many as 300,000 patients annually and account for nearly 1 million additional inpatient days (Loyola University Health Systems, 2017; Centers for Disease Control and Prevention, 2021). The risk of surgical site infection following colorectal surgery is one of the highest when compared to any surgical specialty. Colorectal surgery places a considerable burden on health care systems related to high complication risks, notably surgical site infections, and contributes to poor outcomes and increased readmission rates (Leaper et al., 2020; Turner & Migaly, 2019). In 2020, 3,062 acute care hospitals reported a total of 6,094 surgical site infections related to colorectal surgery (Centers for Disease Control and Prevention, 2020). An increased length of stay not only causes a direct cost to the health care system and payer but also causes patient and social-economical ramifications from the cost of supplies, nursing care, and loss of work and productivity (Turner & Migaly, 2019).
Decreasing the incidence of surgical site infections in colorectal surgery patients is a common theme of all research studies evaluated. These studies all looked at outcomes on surgical site infection rates with the implementation of the Enhanced Recovery After Surgery (ERAS) protocol.
According to one observational study, it was found that participants who underwent colorectal surgery with the implementation of the ERAS protocol, had fewer complications and decreased length of stay (Arrick et al., 2019). The second independent study found that with the implementation of the ERAS protocol, patients had a decreased length of stay with a decrease in readmissions, and a reduction in postoperative complications (Johnson & Fogel, 2017).
I will continue to participate in the case study for this DNP project. It is my hope to be able to present this case study in the future to the organization in which I work once I have completed the case study and have solid evidence from my literature synthesis and data from research to present this to major stakeholders in hopes that the Enhanced Recovery After Surgery (ERAS) protocol can be implemented.
Arrick, L., Mayson, K., Hong, T., & Warnock, G. (2019). Enhanced recovery after surgery in colorectal surgery: Impact of protocol adherence on patient outcomes. Journal of Clinical Anesthesia, 55, 7-12. doi:10.1016/jcliniane.20.18.12.034
Centers for Disease Control and Prevention. (2020). Colon surgical site infections. bhttps://arpsp.cdc.gov/profile/infections/colon (Links to an external site.)
Leaper, D., Holy, C., Spencer, M., Chitnis, A., Hogan, A., Wright, G., Po-Han Chen, B., & Edmiston Jr., C. (2020). Assessment of the risk and economic burden of surgical site infections following colorectal surgery using a US longitudinal database: Is there a role for innovative antimicrobial wound closure technology to reduce the risk of infection? Dis Colon Rectum, 63, 1628-1638. https://doi.10.1097/DCR.0000000000001799
Loyola University Health System. (2017, January 19). Surgical site infections are the most costly of hospital infections: Guidelines for preventing surgical site infections are updated.
Turner, M. & Migaly, J. (2019). Surgical site infection: The clinical and economic impact. Clin Colon Rectal Surg, 32(3), 157-165. https://doi.10.1055/s-0038-1677002