The effect of Surgical Care Improvement Project measures on national trends on surgical site infections in open vascular procedures

• Published in: Journal of vascular surgery 2014-12, Vol.60 (6), p.1635-1639
• Main Authors: Dua, Anahita, MD, MS, MBA, Desai, Sapan S., MD, PhD, MBA, Seabrook, Gary R., MD, Brown, Kellie R., MD, Lewis, Brian D., MD, Rossi, Peter J., MD, Edmiston, Charles E., PhD, Lee, Cheong J., MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - standards; Carotid Artery Diseases - diagnosis; Carotid Artery Diseases - surgery; Chi-Square Distribution; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - standards; Female; Guideline Adherence - standards; Hospital Mortality; Humans; Male; Middle Aged; Outcome and Process Assessment (Health Care) - standards; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - surgery; Practice Guidelines as Topic - standards; Practice Patterns, Physicians' - standards; Program Evaluation; Quality Improvement - standards; Quality Indicators, Health Care - standards; Retrospective Studies; Risk Factors; Surgery; Surgical Wound Infection - diagnosis; Surgical Wound Infection - microbiology; Surgical Wound Infection - mortality; Surgical Wound Infection - prevention & control; Time Factors; Treatment Outcome; United States; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; Vascular Surgical Procedures - standards
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2014.08.072

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 χ2 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.