The article, “Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery: A Systematic Scoping Review,” by Ahuja et al. (2022), addresses the critical issue of surgical site infections (SSIs) and antimicrobial resistance (AMR), which pose significant global threats to patient safety and healthcare quality. Postoperative infections, including SSIs, are a major cause of morbidity, particularly in low and middle-income countries, and often lead to inappropriate antibiotic prescriptions, exacerbating the AMR problem.
The authors highlight that while surveillance methods are known to reduce infection rates, surveillance alone does not automatically lead to improvement. Instead, surveillance must be combined with effective feedback mechanisms to frontline providers to facilitate behavior change. This combined approach is known as “audit-and-feedback” and has demonstrated effectiveness in altering antibiotic prescription practices, improving patient outcomes, and reducing healthcare costs. However, a significant gap exists in the evidence base regarding the optimal details of this feedback—specifically, what information should be provided, in what format, and with what frequency—which limits its effective widespread application in surgery.
To address this gap, this systematic scoping review investigates how “audit-and-feedback” interventions are applied in surgical practice to reduce SSIs and optimize antibiotic usage. The study utilized well-established implementation science frameworks, including the Expert Recommendations for Implementing Change (ERIC) taxonomy for implementation strategies and Proctor’s implementation outcomes taxonomy, to systematically code and analyze the data. Two electronic health databases, MEDLINE and EMBASE, were searched for relevant studies published between 1974 and September 2019.
The review identified 21 studies, predominantly from high-income countries, with the majority focusing on SSI rates (17 studies) and antimicrobial stewardship (10 studies). Key findings indicate that feedback is often part of multimodal interventions, meaning it is offered alongside other strategies. Feedback was most commonly provided in written format (65% of studies), often to department heads, surgeons, or anesthesiologists, and was given individually (40% of studies) or in groups (50% of studies). A critical observation was that feedback rarely cascaded down to frontline perioperative staff such as operating room staff, pharmacists, and nurses (only 30% of studies). While 73% of studies reporting SSI rates showed a significant reduction with the interventions, the direct attributable contribution of feedback was difficult to ascertain due to the bundled nature of interventions. Common additional implementation strategies included stakeholder training and education, and developing relationships among stakeholders, while strategies like engaging consumers or utilizing financial incentives were rarely reported. Fidelity, meaning adherence and compliance with guidelines, was the most frequently reported implementation outcome.
In conclusion, the review highlights a significant need for improved reporting of feedback processes in research on SSI prevention and antibiotic use. Future studies should explicitly detail the recipients of feedback, the specific process employed, and the impact of feedback strategies. The authors recommend that feedback be clinically relevant, both individualized and aggregated, timely, potentially visual, and available to all relevant personnel, fostering goal-setting and quality improvement. They also emphasize the crucial role of surgical leadership in driving effective surveillance and actionable feedback programs.
Reference: Ahuja, S., Peiffer-Smadja, Y. N., Peven, K., White, M., Leather, A. J. M., Singh, S., Mendelson, M., Holmes, A., Birgand, G., & Sevdalis, N. (2022). Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery: A Systematic Scoping Review. Annals of Surgery, 275(2), e345–e352. https://doi.org/10.1097/SLA.0000000000004909
