Evidence that a Regional Surgical Collaborative Can Transform Care: Surgical Site Infection Prevention Practices for Colectomy in Michigan

J Am Coll Surg. 2018 Jan;226(1):91-99. doi: 10.1016/j.jamcollsurg.2017.10.013. Epub 2017 Oct 28.


Background: Surgical site infections (SSI) after colectomy are associated with increased morbidity and health care use. Since 2012, the Michigan Surgical Quality Collaborative (MSQC) has promoted a "bundle" of care processes associated with lower SSI risk, using an audit-and-feedback system for adherence, face-to-face meetings, and support for quality improvement projects at participating hospitals. The purpose of this study was to determine whether practices changed over time.

Study design: We previously found 6 processes of care independently associated with SSI in colectomy. From 2012 to 2016, we promoted a bundle of 3 care measures (cefazolin/metronidazole, oral antibiotics after mechanical bowel preparation, and normoglycemia) in 52 hospitals. Primary outcome was change in use of the 3-item SSI bundle. We also used a hierarchical logistic regression model to assess the association between 6-item compliance and SSI rate, morbidity, and health care use.

Results: The use of cefazolin/metronidazole increased from 18.6% to 32.3% (p < 0.001), oral antibiotic preparation increased from 42.9% to 62.0% (p < 0.001). The increase in normoglycemia was not significant. Concurrently, the SSI rate fell from 6.7% to 3.9% in the 52 hospitals (p = 0.012). Patients receiving more bundle measures had decreased rates of SSI, sepsis, and pneumonia. Morbidity and health care use significantly decreased with increased bundle compliance.

Conclusions: These data show a significant increase in use of process measures promoted by a regional quality improvement collaborative, and an associated decrease in SSI after elective colectomy. These results highlight the promise of regional collaboratives to accelerate practice change and improve outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis / methods*
  • Cathartics / therapeutic use
  • Cefazolin / therapeutic use
  • Colectomy / adverse effects*
  • Elective Surgical Procedures / standards
  • Formative Feedback
  • Guideline Adherence / standards
  • Humans
  • Intersectoral Collaboration
  • Medical Audit
  • Metronidazole / therapeutic use
  • Michigan
  • Patient Care Bundles / standards*
  • Preoperative Care / standards*
  • Quality Improvement / standards*
  • Risk Factors
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / prevention & control*


  • Anti-Bacterial Agents
  • Cathartics
  • Metronidazole
  • Cefazolin