Adherence to Surgical Care Improvement Project Measures and the Association With Postoperative Infections

Stulberg, Jonah J.; Delaney, Conor P.; Neuhauser, Duncan; Aron, David C.; Fu, Pingfu; Koroukian, Siran M.

doi:10.1001/jama.2010.841

Cited by 498 publications

(278 citation statements)

References 27 publications

Supporting

Mentioning

270

Contrasting

Order By: Relevance

“…For example, implementation of Surgical Care Improvement Project (SCIP) measures in adult surgeries led to improved documented compliance rates with SCIP measures but did not necessarily yield improved outcomes in reduction of infections. 14,17 In this study, SCIP measures of preoperative antibiotic administration indeed correlated with improved outcomes in this pediatric population undergoing intrathecal baclofen pump surgeries. There was a significant difference between patients with documented overall bundled compliance with antibiotic prophylaxis and those without documented compliance.…”

Section: Discussionsupporting

confidence: 52%

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Pan

Kuo

Luerssen

et al. 2015

FOC

View full text Add to dashboard Cite

OBJECT This study explored antibiotic prophylaxis (AP) in pediatric patients undergoing intrathecal baclofen pump (ITBP) surgery and factors associated with perioperative AP compliance with clinical guidelines. METHODS Data were obtained from the Pediatric Health Information System. The study cohort comprised patients who underwent ITBP surgery within 3 days of admission, between July 1, 2004, and March 31, 2014, with a minimum prior screening period and follow-up of 180 days. Exclusion criteria were prior infection, antibiotic use within 30 days of admission, and/or missing financial data. Chi-square tests and multivariate logistic regressions were used to determine factors associated with compliance with AP guidelines in ITBP surgeries. RESULTS A total of 1,534 patients met the inclusion criteria; 91.5% received AP and 37.6% received dual coverage or more. Overall bundled compliance comprised 2 components: 1) perioperative antibiotic administration and 2) < 24-hour postoperative antibiotic course. The most frequently used antibiotics in surgery were cefazolin (n = 873, 62.2%) and vancomycin (n = 351, 25%). Documented bundled AP compliance rates were 70.2%, 62.0%, 66.0%, and 55.2% in West, South, Midwest, and Northeast regions of the US, respectively. Compared with surgeries in the Northeast, procedures carried out in the West (OR 2.0, 95% C11.4-2.9, p < 0.001), Midwest (OR 1.6, 95% C11.1-2.3, p = 0.007), and South (OR 1.5, 95% C11.1-2.0, p = 0.021) were more likely to have documented AP compliance. Black (OR 0.74, 95% CI 0.55-1.00, p = 0.05) and Hispanic (OR 0.63, 95% CI 0.47-0.86, p = 0.004) patients were less likely to have documented AP compliance in ITBP surgeries than white patients. There were no significant differences in compliance rate by age, sex, type of insurance, and diagnosis. AP process measures were associated with shorter length of stay, lower hospitalization costs, and lower 6-month rates of surgical infection/complication. One of the 2 noncompliance subgroups, missed preoperative antibiotic administration, was correlated with a significantly higher 6-month surgical complication/infection rate (27.03%) compared with bundled compliance (20.00%, p = 0.021). For the other subgroup, prolonged antibiotic use > 24 hours postoperatively, the rate was insignificantly higher (22.00%, p = 0.368). Thus, of direct relevance to practicing clinicians, missed preoperative antibiotics was associated with 48% higher risk of adverse complication/infection outcome in a 6-month time frame. Adjusted hospitalization costs associated with baclofen pump surgery differed significantly (p < 0.001) with respect to perioperative antibiotic practices: 22.83, 29.10, 37.66 (× 1000 USD) for bundled compliance, missed preoperative antibiotics, and prolonged antibiotic administration, respectively. CONCLUSIONS Significant variation in ITBP antibiotic prophylaxis was found. Documented AP compliance was associated with higher value of care, showing favorable clinical and financial outcomes. Of most impact to clinical outcome, missed preoperative antibiotics was significantly associated with higher risk of 6-month surgical complication/infection. Prolonged antibiotic use was associated with significantly higher hospital costs compared with those with overall bundled antibiotic compliance. Future research is warranted to examine factors associated with practice variation and how AP compliance is associated with outcomes and quality, aiming for improving delivery of care to pediatric patients undergoing ITBP procedures.

show abstract

Section: Discussionsupporting

confidence: 52%

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Pan

Kuo

Luerssen

et al. 2015

FOC

View full text Add to dashboard Cite

show abstract

“…This is not an exhaustive list but serves to provide a structure to consider areas to target for quality improvement. *SCIP, Surgical Care Improvement Project [27]. Editorial Anaesthesia, 2011, 66, pages 435-445 .…”

mentioning

confidence: 99%

Emergency surgery in the elderly patient: a quality improvement approach

Peden¹

2011

Anaesthesia

View full text Add to dashboard Cite

“…Also before 2012, SSI surveillance relied on indirect identification via epidemiology followed by discussion with health care providers on just the NHSN-reportable cases. The Heart Center sought to track the total incidence of SSIs, not just ; a standardized preoperative inpatient and outpatient skin preparation protocol with either CHG or Sage Comfort Bath (Sage Products LLC), depending on the patient's age 4,11 ; education of outpatients' families and inpatient hospital staff on CHG or Sage Comfort Bath bathing requirements 11,12 ; standardized perioperative antibiotic (cefazolin) dosing, timing, and redosing (based on the patient's weight and gestational age) 4,[11][12][13] ; and multidisciplinary meetings after detection of every suspected SSI to discuss root cause and potential interventions. In early 2013, use of standardized silver-impregnated dressings, which are removed on postoperative day 7, was added for all postoperative surgical sites.…”

Section: Planning the Interventionmentioning

confidence: 99%

Improving Surveillance and Prevention of Surgical Site Infection in Pediatric Cardiac Surgery

Cannon

Hersey

Harrison

et al. 2016

American Journal of Critical Care

View full text Add to dashboard Cite

Background Postoperative cardiovascular surgical site infections are preventable events that may lead to increased morbidity, mortality, and health care costs. Objective To improve surgical wound surveillance and reduce the incidence of surgical site infections. Methods An institutional review of surgical site infections led to implementation of 8 surveillance and process measures: appropriate preparation the night before surgery and the day of surgery, use of appropriate preparation solution in the operating room, appropriate timing of preoperative antibiotic administration, placement of a photograph of the surgical site in the patient’s chart at discharge, sending a photograph of the surgical site to the patient’s primary care physician, 30-day follow-up of the surgical site by an advanced nurse practitioner, and placing a photograph of the surgical site obtained on postoperative day 30 in the patient’s chart. Results Mean overall compliance with the 8 measures from March 2013 through February 2014 was 88%. Infections occurred in 10 of 417 total operative cases (2%) in 2012, in 8 of 437 total operative cases (2%) in 2013, and in 7 of 452 total operative cases (1.5%) in 2014. Conclusions Institution of the surveillance process has resulted in improved identification of suspected surgical site infections via direct rather than indirect measures, accurate identification of all surgical site infections based on definitions of the National Healthcare Safety Network, collaboration with all persons involved, and enhanced communication with patients’ family members and referring physicians.

show abstract

Adherence to Surgical Care Improvement Project Measures and the Association With Postoperative Infections

Cited by 498 publications

References 27 publications

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Emergency surgery in the elderly patient: a quality improvement approach

Improving Surveillance and Prevention of Surgical Site Infection in Pediatric Cardiac Surgery

Contact Info

Product

Resources

About