Discordance between surgical care improvement project adherence and postoperative outcomes: implications for new Joint Commission standards. J Surg Res 2017 May 15;212:205-213
Date
05/30/2017Pubmed ID
28550908DOI
10.1016/j.jss.2017.01.006Scopus ID
2-s2.0-85013418920 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
BACKGROUND: Infectious (INF) and venous thromboembolism (VTE) complication rates are targeted by surgical care improvement project (SCIP) INF and SCIP VTE measures. We analyzed how adherence to SCIP INF and SCIP VTE affects targeted postoperative outcomes (wound complication [WC], deep vein thrombosis, and pulmonary embolism [PE]) using all-payer data.
MATERIALS AND METHODS: A retrospective review (2007-2011) was conducted using Healthcare Cost and Utilization Project State Inpatient Database Florida and Medicare's Hospital Compare. The association between SCIP adherence rates and outcomes across 355 included surgical procedures was measured using multilevel mixed-effects linear regression models.
RESULTS: One hundred sixty acute care hospitals and 779,922 patients were included. Over 5 y, SCIP INF-1, -2, and -3 adherence improved by 12.5%, 8.0%, and 20.9%, respectively, whereas postoperative WC rate decreased by 14.8%. When controlling for time, SCIP INF-1 adherence was associated with improvement of postoperative WC rates (β = -0.0044, P = 0.005), whereas SCIP INF-2 adherence was associated with increased WCs (β = 0.0031, P = 0.018). SCIP VTE-1, -2 adherence improved by 14.6% and 20.2%, respectively, whereas postoperative deep vein thrombosis rate increased by 7.1% and postoperative PE rate increased by 3.7%. SCIP VTE-1 and -2 adherence were both associated with increased postoperative PE when controlling for time (SCIP VTE-1: β = 0.0019, P < 0.001; SCIP VTE-2: β = 0.0015, P < 0.001). Readmission analysis found SCIP INF-1 adherence to be associated with improved 30-d WC rates when controlling for patient and hospital characteristics (β = -0.0021, P = 0.032), whereas SCIP INF-3 adherence was associated with increased 30-d WC rates when controlling for time (β = 0.0007, P = 0.04).
CONCLUSIONS: Only SCIP INF-1 adherence was associated with improved outcomes. The Joint Commission has retired SCIP INF-2, -3, and SCIP VTE-2 and made SCIP INF-1 and VTE-1 reporting optional. Our study supports continued reporting of SCIP INF-1.
Author List
Chang V, Blackwell RH, Markossian T, Yau RM, Blanco BA, Zapf MAC, Abood GJ, Gupta GN, Kuo PC, Kothari ANAuthor
Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Female
Florida
Follow-Up Studies
Guideline Adherence
Humans
Linear Models
Male
Medicare
Middle Aged
Perioperative Care
Postoperative Complications
Practice Guidelines as Topic
Pulmonary Embolism
Quality Improvement
Retrospective Studies
Surgical Wound Infection
United States
Venous Thrombosis