• Niels Wolfhagen, BoldinghQuirine J JQJJAmsterdam UMC location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands.Amsterdam Gastroenterology Endocrinology & Metabolism (AGEM), Amsterdam, the Netherlands., Marja A Boermeester, and Stijn W de Jonge.
• Amsterdam UMC location University of Amsterdam, Department of Surgery, Meibergdreef 9, Amsterdam, the Netherlands.
• Br J Surg. 2022 Sep 9; 109 (10): 933942933-942.

BackgroundCare bundles are used widely to prevent surgical-site infections (SSIs). Recent systematic reviews suggested larger effects from bundles with more interventions. These reviews were largely based on uncontrolled before-after studies and did not consider their biases. The aim of this meta-analysis was to determine the effectiveness of care bundles to prevent SSIs and explore characteristics of effective care bundles.MethodsA systematic review, reanalysis, and meta-analysis of available evidence were undertaken. RCTs, controlled before-after studies, and uncontrolled before-after studies with sufficient data for reanalysis as interrupted time series studies (ITS) were eligible. Studies investigating the use of a care bundle, with at least one intraoperative intervention, compared with standard care were included.ResultsFour RCTs, 1 controlled before-after study, and 13 ITS were included. Pooled data from RCTs were heterogeneous. Meta-analysis of ITS resulted in a level change of -1.16 (95 per cent c.i.-1.78 to -0.53), indicating a reduction in SSI. The effect was larger when the care bundle comprised a higher proportion of evidence-based interventions. Meta-regression analyses did not show statistically significant associations between effect estimates and number of interventions, number of evidence-based interventions, or proportion of evidence-based interventions.ConclusionMeta-analysis of ITS indicated that perioperative care bundles prevent SSI. This effect is inconsistent across RCTs. Larger bundles were not associated with a larger effect, but the effect may be larger if the care bundle contains a high proportion of evidence-based interventions. No strong evidence for characteristics of effective care bundles was identified.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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