Post-Hawthorne effect: Rise in SSI after bundle implementation in combined liver-colorectal surgery

Background: Surgical site infections (SSI) cause significant morbidity and mortality after combined liver-colorectal resections. Implementation of a perioperative bundle in 2013 reduced SSI by 60% at our high-volume cancer center (Tufts, 2019). Surgeons noted increasing SSI after study completion, raising concerns about bundle compliance and prompting a re-evaluation of patient- and procedure-specific drivers of SSI in our population.