Surgical Care Improvement Project (SCIP): Has Its Mission Succeeded?

Rasouli, Mohammad R.; Jaberi, Mehrad Mojtahed; Hozack, William J.; Parvızı, Javad; Rothman, Richard H.

doi:10.1016/j.arth.2013.03.004

Cited by 21 publications

(15 citation statements)

References 13 publications

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“…Although the stated intention of CMS in implementing SCIP was reduction of preventable surgical complications, thus far the results of SCIP have been mixed. 11,12 In fact, a recent review of Medicare data demonstrated an increase in complication rates for surgical patients between 2005 and 2011. 13 One factor that may be impacting the lack of results for these quality measures is a failure to adequately risk-stratify surgical patients.…”

Section: Discussionmentioning

confidence: 98%

Risk Modeling Predicts Complication Rates for Spinal Surgery

Kimmell

Algattas

Joynt

et al. 2015

SPINE

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Section: Discussionmentioning

confidence: 98%

Risk Modeling Predicts Complication Rates for Spinal Surgery

Kimmell

Algattas

Joynt

et al. 2015

SPINE

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“…33 A number of studies have assessed the impact of SCIP on outcomes, including surgical infections in mostly noncardiac surgery, however, with mixed results. 34,35 Although several SCIP measures have been retired recently (January 2015), continuing evaluation of practice standardization and outcomes and implementation barriers of SCIP measures will be crucial in its success.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery

Poeran

Mazumdar

Rasul

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Objective Antibiotic use, particularly type and duration, is a crucial modifiable risk factor for Clostridium difficile. Cardiac surgery is of particular interest because prophylactic antibiotics are recommended for 48 hours or less (vs ≤24 hours for noncardiac surgery), with increasing vancomycin use. We aimed to study associations between antibiotic prophylaxis (duration/vancomycin use) and C difficile among patients undergoing coronary artery bypass grafting. Methods We extracted data on coronary artery bypass grafting procedures from the national Premier Perspective claims database (2006–2013, n = 154,200, 233 hospitals). Multilevel multivariable logistic regressions measured associations between (1) duration (<2 days, “standard” vs ≥2 days, “extended”) and (2) type of antibiotic used (“cephalosporin,” “cephalosporin + vancomycin,” “vancomycin”) and C difficile as outcome. Results Overall C difficile prevalence was 0.21% (n = 329). Most patients (59.7%) received a cephalosporin only; in 33.1% vancomycin was added, whereas 7.2% received vancomycin only. Extended prophylaxis was used in 20.9%. In adjusted analyses, extended prophylaxis (vs standard) was associated with significantly increased C difficile risk (odds ratio, 1.43; confidence interval, 1.07–1.92), whereas no significant associations existed for vancomycin use as adjuvant or primary prophylactic compared with the use of cephalosporins (odds ratio, 1.21; confidence interval, 0.92–1.60, and odds ratio, 1.39; confidence interval, 0.94–2.05, respectively). Substantial inter-hospital variation exists in the percentage of extended antibiotic prophylaxis (interquartile range, 2.5–35.7), use of adjuvant vancomycin (interquartile range, 4.2–61.1), and vancomycin alone (interquartile range, 2.3–10.4). Conclusions Although extended use of antibiotic prophylaxis was associated with increased C difficile risk after coronary artery bypass grafting, vancomycin use was not. The observed hospital variation in antibiotic prophylaxis practices suggests great potential for efforts aimed at standardizing practices that subsequently could reduce C difficile risk.

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“…The validity of findings from studies that do not present compliance data must be questioned. 13,14 Having so many elements in a care bundle may present an inherent flaw in its implementation and the ability to achieve compliance. Equally, as the DH HII SSI care bundle is spread over pre, intra and postoperative periods, it involves several clinical teams, which may also limit compliance and effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery

Tanner

Kiernan

Hilliam

et al. 2016

annals

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INTRODUCTIONIn 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery. METHODS A prospective cohort design was used at two teaching hospitals in England. The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months. SSI and care bundle compliance data were collected using dedicated surveillance staff. RESULTS Just under a quarter (24%) of the patients in the baseline group developed a SSI compared with just over a quarter (28%) in the care bundle group (p>0.05). However, compliance rates with individual interventions, both before and after the implementation of the bundle, were similar. Interestingly, in only 19% of cases was there compliance with the total care bundle. The single intervention that showed an associated reduction in SSI was preoperative warming (p=0.032). CONCLUSIONS The DH care bundle did not reduce SSIs after open colorectal surgery. Despite this, it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar. All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle; poor compliance may be one of the reasons for the lower than expected reduction of SSIs.

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Surgical Care Improvement Project (SCIP): Has Its Mission Succeeded?

Cited by 21 publications

References 13 publications

Risk Modeling Predicts Complication Rates for Spinal Surgery

Risk Modeling Predicts Complication Rates for Spinal Surgery

Antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery

Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery

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