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The effect of Surgical Care Improvement Project measures on national trends on surgical site infections in open vascular procedures. J Vasc Surg 2014 Dec;60(6):1635-9 PMID: 25454105

Pubmed ID

25454105

DOI

10.1016/j.jvs.2014.08.072

Abstract

OBJECTIVE: The Surgical Care Improvement Project (SCIP) is a national initiative to reduce surgical complications, including postoperative surgical site infection (SSI), through protocol-driven antibiotic usage. This study aimed to determine the effect SCIP guidelines have had on in-hospital SSIs after open vascular procedures.

METHODS: The Nationwide Inpatient Sample (NIS) was retrospectively analyzed using International Classification of Diseases, Ninth Revision, diagnosis codes to capture SSIs in hospital patients who underwent elective carotid endarterectomy, elective open repair of an abdominal aortic aneurysm (AAA), and peripheral bypass. The pre-SCIP era was defined as 2000 to 2005 and post-SCIP was defined as 2007 to 2010. The year 2006 was excluded because this was the transition year in which the SCIP guidelines were implemented. Analysis of variance and χ(2) testing were used for statistical analysis.

RESULTS: The rate of SSI in the pre-SCIP era was 2.2% compared with 2.3% for carotid endarterectomy (P = .06). For peripheral bypass, both in the pre- and post-SCIP era, infection rates were 0.1% (P = .22). For open, elective AAA, the rate of infection in the post-SCIP era increased significantly to 1.4% from 1.0% in the pre-SCIP era (P < .001). Demographics and in-hospital mortality did not differ significantly between the groups.

CONCLUSIONS: Implementation of SCIP guidelines has made no significant effect on the incidence of in-hospital SSIs in open vascular operations; rather, an increase in SSI rates in open AAA repairs was observed. Patient-centered, bundled approaches to care, rather than current SCIP practices, may further decrease SSI rates in vascular patients undergoing open procedures.

Author List

Dua A, Desai SS, Seabrook GR, Brown KR, Lewis BD, Rossi PJ, Edmiston CE, Lee CJ

Authors

Brian D. Lewis MD Professor in the Surgery department at Medical College of Wisconsin
Peter J. Rossi MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin
Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-84925225354   19 Citations

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Anti-Bacterial Agents
Aortic Aneurysm, Abdominal
Blood Vessel Prosthesis Implantation
Carotid Artery Diseases
Chi-Square Distribution
Endarterectomy, Carotid
Female
Guideline Adherence
Hospital Mortality
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Peripheral Arterial Disease
Practice Guidelines as Topic
Practice Patterns, Physicians'
Program Evaluation
Quality Improvement
Quality Indicators, Health Care
Retrospective Studies
Risk Factors
Surgical Wound Infection
Time Factors
Treatment Outcome
United States
Vascular Surgical Procedures
jenkins-FCD Prod-353 9ccd8489072cb19f5b9f808bb23ed672c582f41e