The participation of health care centers in the National Surgical Quality Improvement Program (NSQIP) has been beneficial in the reduction of morbidity and mortality. This has been achieved through the assessment of preoperative risk factors, postoperative occurrences, mortality reports, surgical site infections, and patient variable statistics. The authors note a significant reduction in SSIs with the compliance of medical institutions to SCIP measures. The increase in compliance was achieved through training sessions for both nurses and surgeons on proper timing and administration of antibiotics. During the study period, the authors note an increase in compliance with SCIP measures from 38% to 92% and a significant decrease in superficial SSI by 38%. As such, the authors suggest that proper administration of antibiotics, as well as proper placement of razors and clippers in the surgical theatres and emphasis on normal thermic, reduces SSIs.
The incidences of venous thromboembolism (VTE), which comprises both deep vein thrombosis (DVT) and pulmonary embolism (PE) events, have been on the increase in the United States, in the last few decades. The risk of VTE is higher for patients with a history of cancer, VTE, or various heart-related diseases, as well as respiratory failure, surgery, shock, increased age, and stillness. The authors also suggest that VTE rates are dependent on both the length of the postoperative period and the type of surgical procedure, such as orthopedic, abdominal, or cardiothoracic surgeries. The authors claim that cancer patients have a higher risk of VTE, though the type of treatment administered to a patient is more dependent on the type of surgical procedure performed than the risk of VTE.
Surgical site infection (SSI) is the most common surgical complication with numerous implications to consumers, payers, and providers. As a result, the National Surgical Infection Prevention (SIP) project was established in 2004 to minimize SSIs, with particular emphasis on the use of prophylactic antibiotics. This body was later transformed to SCIP, which developed process measures based on evidence-based practice to support process measures proposed by the SIP project. The authors suggest that sustained efforts of health care providers enhance their compliance to multiple SCIP process measures in the effort to reduce SSIs, though the increase in compliance does not result in a significant decrease in SSI rates. The authors identify various challenges in the appropriate administration of prophylactic antibiotics before incision, redosing where necessary, and termination of antibiotics 24 hours after the surgery, especially in patients with drains. However, compliance to the SCIP measures was enhanced by an alternative selection of antibiotics based on the temperature of the patients during surgery. The study does not indicate a relation between perioperative glucose control and wound infection in patients undergoing cardiac surgery. While the study does not achieve the targeted 95% compliance to SCIP measures, the authors note that compliance can be increased by overcoming various obstacles such as increasing availability of antibiotics, administration of antibiotics within the surgery room, and tracking and adjusting the patient temperature needs to reduce SSI outcomes.
One of the SCIP measures involves the administration of antimicrobial prophylaxis before the incision to reduce the risk of surgical site infections. The time of administration is key since the efficacy of the antimicrobials diminishes if administered too early, or disappears if administered after the incision. As a way to promote proper antimicrobial prophylaxis, the SCIP measures stipulate the choice of antimicrobial agent, as well as, the timing and duration of surgical prophylaxis. The authors attempt to show the correlation between timing and duration of antibiotics, as well as the interoperative redosing of surgical antimicrobial prophylaxis, and risk of SSI. In this regard, the authors suggest that the latter is effective in reducing the risk of SSI for surgeries that take more than four hours. Additionally, the authors confirm other studies that show reduced risk with the administration of antibiotics with short infusion times within half an hour before incision.
The Surgical Care Improvement Project (SCIP) developed 20 different measures targeting multiple elements of surgical patient care. Out of the nine that are publicly reported, two-thirds of them are aimed at the prevention of post-operative infections. Numerous researches have been conducted to verify the efficacy of these measures, as well as to enhance their development and implementation in the effort to enhance the quality of medical care. Hospitals are encouraged to participate in the data collection process to attain 100% reimbursement from the Centers of Medicare and Medicaid Services (CMS). While there has been the considerable motivation for the collection of data, there is still minimal effort directed towards the evaluation of the effectiveness of these process-of-care measures in enhancing the outcomes in routine clinical care. AS such, the authors aim at finding out the correlation between the six infection-prevention SCIP measures and postoperative infection prevalence in various hospitals in the United States. The authors suggest that there is a positive correlation between the adherence of hospitals to SCIP process-of-care measures and improved patient outcomes due to the reduced probability of developing a postoperative infection.
References
Berenguer, C. M., Ochsner, G., Lord, A., & Senkowski, C. K. (2010). Improving Surgical Site Infections: Using National Surgical Quality Improvement Program Data to Institute Surgical Care Improvement Project Protocols in Improving Surgical Outcomes. J Am Coll Surg, 210(5), 737-741.
Hammond, J., Kozma, C., Hart, J. C., Nigam, S., Daskiran, M., Paris, A., et al. (2011). Rates of Venous Thromboembolism Among Patients with Major Surgery for Cancer. Ann Surg Oncol, 18, 3240–3247.
Pastor, C., Artinyan, A., Varma, M. G., Kim, E., Gibbs, L., & Garcia-Aguilar, J. (2010). An Increase in Compliance With the Surgical Care Improvement Project Measures Does Not Prevent Surgical Site Infection in Colorectal Surgery. Diseases of the Colon & Rectum Volume, 53: 1, 24-29.
Steinberg, J. P., Braun, B. I., Hellinger, W. C., & Kusek, L. (2009). Timing of Antimicrobial Prophylaxis and the Risk of Surgical Site Infections. Annals of Surgery, 250(1), 10-16.
Stulberg, J. J., Delaney, C. P., & Neuhauser, D. V. (2010). Adherence to Surgical Care Improvement Project Measures and the Association With Postoperative Infections. JAMA, 303(24), 2479-2485.