Summary

A Clinical Practice Improvement study was conducted at eight West Coast hospitals to determine areas of significant improvement in the management of abdominal surgery patients.  Data were collected on over 1,000 patients, and extensive multivariate analyses were performed. Use of a patient controlled analgesia pump was significantly associated with increased post-operative wound infections after controlling for many variables including severity of illness.

Primary Objectives

1. Improve measurable customer value by optimizing clinical outcomes, service, and price throughout the continuum of care in adult abdominal surgery.

2. Reduce rate of occurrence of surgical wound infections.

3. Create optimal treatment research-based dynamic protocols.

Methods

Data were collected on over 1,000 patients 18 years old.  Study hospitals included a 116-bed rural hospital, a major urban facility serving a high proportion of low-income patients, and a university teaching hospital.  Outcomes assessed included length of stay, cost, post-operative infection, and increase in severity of illness from admission (first 24 hours) to maximum during hospital stay.  Multivariate analyses were performed on all data.

METHODS (continued)

The use of a patient controlled analgesia pump occurred in 214 of 515 randomly selected patients who had rectal or major bowel surgery.

Confounding variables controlled for included severity of illness at admission, body mass index, pre-admission use of corticosteroids, rupture of organ, number of previous abdominal operations, wound category, hypothermia, malnutrition on admission, pre-operative antibiotic use within 2 hours before incision, anesthesia start to incision time, surgical skin to skin time, use of drains, mobility assistance required, and surgeon.

results

1. After controlling for many variables, use of PCA pumps was associated with a higher rate of post-operative surgical wound infection: 10.7% for PCA users vs. 4.0% for non PCA users (p = .004)

2. After controlling for many variables, use of PCA pumps was associated with longer length of stay.

Impact

Additional study is needed to further elucidate possible immunologic effects of PCA pumps.