Has the Surgical Care Improvement Program Improved Outcomes?
Mary T Hawn, MD*1, Kamal MF Itani, MD*2, Catherine C Vick, MD*3, William G Holman, MD1
1University of Alabama at Birmingham, Birmingham, AL;2Boston VAMC, Boston, MA;3Birmingham VAMC, Birmingham, AL
Background: The Surgical Care Improvement Project (SCIP) was established in 2006 with the goal of reducing surgical complications by 25% in 2010.
Methods: National VA data from 2005-2009 on adherence to five SCIP surgical site infection (SSI) prevention measures were linked to VASQIP SSI outcome data. Effect of SCIP adherence and year of surgery on SSI outcome were assessed with logistic regression using generalized estimating equations, adjusting for procedure type and validated patient SSI risk score. Hospital correlation of SCIP adherence and SSI rate was assessed using linear regression.
Results: There were 61,099 surgeries at 112 VA hospitals analyzed. SCIP adherence ranged from 75% for normothermia to 99% for hair removal and all significantly improved over the study period (p<0.001). Surgical site infection occurred after 6.2% of surgeries (1.6% for orthopedic surgeries to 11.3% for colorectal surgeries). None of the five SCIP measures was significantly associated with lower odds of SSI after adjusting for SSI risk index and procedure type (Table). Year was not significantly associated with SSI (p=0.71). Hospital SCIP performance was not correlated with hospital SSI rates (r=-0.06, p=0.54).
Conclusions: Adherence to SCIP measures improved whereas risk adjusted SSI rates remained stable. SCIP adherence was neither associated with a lower SSI rate at the patient level, nor associated with hospital SSI rates. Policies regarding continued SCIP measurement and reporting should be reassessed.
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