1405. Performance on SCIP Measures and Risk of Surgical Site Infection
Session: Oral Abstract Session: Predicting and Preventing SSIs
Sunday, October 23, 2011: 8:00 AM
Room: 157ABC
Background: The Surgical Care Improvement Project (SCIP) promotes improvement on evidence-based measures linked to reduced surgical complications. Recent studies have failed to show better patient outcomes in hospitals with higher performance on the measures but were limited by lack of patient-level data, limited groups of hospitals, or lack of post-discharge outcomes data. We conducted an analysis of national SCIP data linking patient-specific measure performance to in-hospital and 30-day postoperative outcomes derived from administrative data.

Methods: We analyzed SCIP data on fee-for-service Medicare patients aged > 65 years from 2007-2009. We calculated the ratio of outcomes (mortality, readmission, surgical site infection [SSI]) for patients excluded from the measures compared to patients who were eligible. We evaluated outcomes for measure-eligible patients who passed SCIP measures compared to eligible patients who did not pass in a multi-level analysis adjusted for age, gender, race, income, Charlson index, surgery type, admission type, and hospital effect.

Results: There were 1,638,756 cases from 3936 hospitals analyzed. Patients excluded from SCIP measures had higher rates of adverse outcomes (e.g., in 2009, patients excluded from the pre-incision antibiotic timing measure were > 4 times as likely to die in-hospital and at 30-days, 1.5 times as likely to be readmitted, and 2.3 times as likely to have a SSI). In multi-level analysis patients passing the measures were less likely to have adverse outcomes (in 2009, a patient that passed antibiotic timing: in-hospital death – adjusted odds ratio [aOR] 0.56, 95% CI 0.51-0.62, P<.001; 30-day death – aOR 0.61, 95% CI 0.56-0.67, P<.001; in-hospital SSI – aOR 0.79, 95% CI 0.67-0.93, P=.004; 30-day postoperative SSI – aOR 0.83, 95% CI 0.75-0.92, P<.001]. The measure on hair removal was an exception (2009:  in-hospital SSI – aOR 1.12, 95% CI 0.84-1.48, P=.45; 30-day SSI – aOR 1.10, 95% CI 0.91-1.34, P=.32.)

Conclusion: With the exception of the hair removal measure, eligible patients who passed the SCIP infection measures had better outcomes including fewer surgical infections as compared to patients who did not pass the measures. Patients excluded from SCIP measures had much worse outcomes.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Dale Bratzler, DO, MPH1, Allen Ma, PhD1, Wato Nsa, MD1, Kristie Baus, RN, MS2, Michael Rapp, MD, JD2, Lee Fleisher, MD3 and Patchen Dellinger, MD, FIDSA4, (1)Oklahoma Foundation for Medical Quality, Oklahoma City, OK, (2)Quality Measures Health Assessment Group, Centers for Medicare & Medicaid Services, Baltimore, MD, (3)Anesthesiology & Critical Care, University of Pennsylvania Health System, Philadelphia, PA, (4)University of Washington Medical Center, Seattle, WA

Disclosures:

D. Bratzler, None

A. Ma, None

W. Nsa, None

K. Baus, None

M. Rapp, None

L. Fleisher, Pfizer: Grant Investigator, Research grant

P. Dellinger, Merck: Consultant, Consulting fee

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.