Adherence to National Prevention Measures for Surgical Site Infection Does Not Impact VA Surgical Outcomes
BACKGROUND:
The Surgical Care Improvement Project (SCIP) was implemented in 2006 with the goal of reducing surgical complications by 25% by 2010. The SCIP is a nationwide quality improvement effort focused on reducing post-operative surgical site infections, thromboembolic, and cardiac events. The SCIP has been implemented by the Centers for Medicare and Medicaid Services (CMS) and has been endorsed by numerous stakeholders as a valid measure of surgical quality. Numerous studies have demonstrated that adherence to the SCIP measures has improved over the implementation period, but only a few have assessed whether adherence has resulted in improved surgical outcomes. This retrospective cohort study evaluated whether the SCIP improved surgical site infection (SSI) rates at the VA patient or hospital level. Using national VA data from 2005 to 2009, investigators linked adherence to 5 SCIP surgical site infection prevention measures to outcome data from VA's Surgical Quality Improvement Program (VASQIP) for 60,853 surgeries performed on Veterans in 112 VA hospitals. [The VASQIP collects an array of data for most Veterans undergoing major surgery in VA hospitals.] The 5 SCIP infection prevention measures included in this analysis were: 1) prophylactic antibiotic administration timing, 2) appropriate antibiotic selection, 3) discontinuation of prophylactic antibiotic within 24-48 hours, 4) appropriate hair removal from surgical site, and 5) normothermia (post-operative temp >96.8°F).
FINDINGS:
- None of the 5 SCIP infection prevention measures were significantly associated with lower odds of SSI among Veterans after adjusting for variables known to predict SSI and procedure type. Individual hospital SCIP performance also was not associated with hospital SSI rates.
- While adherence to SCIP measures improved, risk-adjusted SSI rates remained stable.
- Overall adherence to the SCIP measures ranged from 75% for normothermia to 99% for hair removal. For Veterans with all measures assessed, the composite rate of adherence was 81%.
- Although SCIP measures are best practices and should continue, they may not discriminate hospital quality. Mandatory SCIP reporting without improvement in care may lead to health professional skepticism and fatigue with quality improvement measures.
LIMITATIONS:
- Investigators were unable to assess outcomes in Veterans undergoing cardiac procedures, thus could not draw conclusions about the effectiveness of the SCIP in the cardiac surgical cohort.
- These findings may not be generalizable to women.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (PPO 10-296). Drs. Hawn and Richman and Ms. Vick are part of HSR&D's Center for Surgical, Medical Acute Care Research and Transitions, Birmingham, AL.
Hawn M, Vick C, Richman J, et al. Surgical Site Infection Prevention: Time to Move Beyond the Surgical Care Improvement Program. Annals of Surgery September 2011;254(3):494-99.
