Mixed Results on the Effectiveness of Surgical Care Improvement Measures

A new study on adherence to surgical care improvement measures has found that when analyzed as a composite infection-prevention score, the improvement measures were associated with a lower probability of postoperative infection; however, adherence to each individual measure separately was not associated with a significantly lower risk of infection.

Researchers at Case Western Reserve University (Cleveland, OH, USA) conducted a study to evaluate the association between the six infection-prevention Surgical Care Improvement Project (SCIP) measures and postoperative infection rates in a representative sample of hospital discharges in the United States. The study included data for discharges between July 2006 and March 2008 of 405,720 patients from 398 hospitals for whom SCIP performance was recorded and submitted for public report. Three of the original infection-prevention measures (S-INF-Core) and all six infection-prevention measures (S-INF) were aggregated into two separate all-or-none composite scores. The processes measured included prophylactic antibiotic administration, glucose control, hair removal from the surgical site, and maintaining normal body temperature during surgery.

The results showed that there were 3,996 documented postoperative infections. Demonstrated adherence to SCIP as measured through the all-or-none global composite S-INF was associated with a decreased likelihood of developing a postoperative infection, dropping from 14.2 to 6.8 postoperative infections per 1,000 discharges. The researchers pointed out, however, that the S-INF-Core composite score itself was not statistically significant in its association with decreased likelihood of developing a postoperative infection; nor was reported adherence on individual SCIP items associated with decreased risk of postoperative infection. The study was published in the June 23, 2010, issue of the Journal of the American medical Association (JAMA).

"Based on our findings, the individual item performance rates reported publicly do not fulfill their stated purpose of pointing consumers toward high-quality hospitals. However, when taken in aggregate, improved performance on our global all-or-none composite measure is associated with improved outcomes at the discharge level,” concluded lead author Jonah Stulberg, M.D., Ph.D., M.P.H., and colleagues. "Therefore, while the individual items may not imply quality differences, the overall ability to demonstrate adherence to multiple SCIP processes of care may.”

The Surgical Care Improvement Project (SCIP) is a U.S. national quality partnership dedicated to reducing the rate of surgical complications that has developed 20 measures covering various discrete elements of patient care. Partners in SCIP believe that a meaningful reduction in surgical complications depends on surgeons, anesthesiologists, perioperative nurses, pharmacists, infection control professionals, and hospital executives working together to intensify their commitment to making surgical care improvement a priority.

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