Conclusion:There is no association between rates of venous thromboembolism (VTE) and adherence to the Surgical Care Improvement Program (SCIP) implemented measures to reduce VTE.Summary: SCIP was implemented by the Centers for Medicare and Medicaid Services (CMS) in 2006. The goal of SCIP is to reduce surgical complications, surgical site infections, adverse cardiac events, and thromboembolism by 25%. SCIP is a core measure collected by the Joint Commission. In-hospital adherence to SCIP measures is reported publicly. Deep venous thrombosis and pulmonary embolism are known to be potentially significant causes of postoperative morbidity and mortality. SCIP introduced two VTE prophylactic measures for surgical procedures as reflected in guidelines from the American College of Chest Physicians. SCIP-VTE-1 measures whether VTE prophylaxis was ordered, and SCIP-VTE-2 measures whether prophylaxis was received; both #24 hours of surgery. This study sought to determine the rates of adherence to SCIP-VTE guidelines, to identify factors for nonadherence, and to analyze relationships between SCIP guideline adherence and VTE events in the context of other patient and procedure factors. This was a retrospective cohort study of data from the VA Surgical Quality Improvement Program from 2006 to 2009. There were 30,531 surgeries analyzed. Patient demographics, comorbidities, and surgical characteristics associated with VTE were summarized. VTE rates were compared by SCIP-VTE adherence. VTE was modeled by adherence to SCIP and adjusting for multiple associated factors using multivariable logistic regression. Of the 30,531 surgeries evaluated, 89.9% adhered to SCIP-VTE, and 1.4% experienced VTE. Obesity, smoking, functional status, weight loss, emergency status, age >64 years, and surgical time were identified by logistic regression to be associated with VTE. SCIP-VTE adherence was not associated with VTE (1.4% vs 1.33%; P ¼ .3). The lack of association of SCIP-VTE with VTE remained even after adjustment for compounding variables.Comment: Most prior analyses of SCIP measures have focused on surgical site infection. These analyses have not provided convincing evidence that adherence to SCIP surgical site infection measures reduces the rate of surgical site infections. Similarly, this study suggests compliance with SCIP-VTE prevention measures has no measurable association with events that are intended to be prevented by adherence to the SCIP-VTE measures. SCIP-VTE measures may be ineffective or too limited to compensate for the large variation and complexity of patient and surgical factors contributing to VTE. No one will argue that reduction of surgical associated VTE is a desirable goal. However, the SCIP regulations should be considered for elimination or modification if they are not found to produce their intended results.

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