Medicare’s SCIP measures do not lower infection rate

Effort and expense of implementing federally mandated measures to reduce surgical-site infections needs to be re-evaluated, study suggests.

Surgical Care Improvement Project measures the Center for Medicare and Medicaid Services required hospitals to implement neither decreased the likelihood that patients developed a surgical-site infection nor did they reduce the institutions’ rate of surgical-site infections, says research from the University of Alabama at Birmingham in the Aug. 25, 2011, online edition of the Annals of Surgery.

surgery_story“Hospitals, surgeons and anesthesiologists have put tremendous effort and resources into meeting these SCIP measures with faith that outcomes for their patients would be improved,” said lead author Mary T. Hawn, M.D., chief of gastrointestinal surgery in the UAB Department of Surgery. “However, there is minimal evidence to support that,” Hawn said.

“The policy of implementing measures, publicly reporting them and threatening hospitals with reduced payment in the absence of evidence that performance on these measures actually matters needs to be re-examined,” Hawn said.

SCIP measures are reported publicly on to help guide patients to high-quality hospitals, but she said this study proves that information is at best non-informative and potentially misleading for patients.

Numerous studies have demonstrated that hospitals’ adherence to CMS SCIP measures has improved since 2006, but few have assessed improvement in surgical outcomes, Hawn said. She and colleagues examined National Veterans’ Affairs data gathered from 2005 to 2009 to assess adherence to these measures and surgical-site infection rates among adherents.

The research team examined 60,853 surgeries performed at 112 VA hospitals that used at least one SCIP infection-prevention measure on cardiac, hip or knee replacement, hysterectomy, colorectal or arterial vascular surgeries. The measures include surgical site hair-removal, maintaining normal body temperature, administering pre-surgery antibiotics, prescribing the appropriate antibiotic and discontinuing antibiotics within 24 hours following surgery.

Hawn said the overall adherence to the SCIP measures in their data set ranged from 75 percent for normal body temperature after surgery to 99 percent for hair removal. Surgeries for patients with complicating conditions, more complex surgeries and colorectal procedures were less likely to receive SCIP measures and more likely to result in a surgical-site infection.

“However, after adjusting for patient and procedure factors associated with surgical-site infections — including whether it was an emergent or elective procedure, the type of surgery, the condition of the wound area and the length of the operation — we found that there was not a significant association between adherence to SCIP measures and the likelihood a patient would develop a surgical-site infection,” Hawn said.

“Nor did we find that patients who received all the measures, reported previously as an all-or-none composite measure, were less likely to develop surgical-site infections. To confirm the findings, we performed numerous sensitivity analyses using different modeling methods, and none demonstrated an association between SCIP-adherence and surgical-site infections.”

Hawn said the findings are important because this study, while consistent with prior assessments of SCIP infection-prevention measures, addresses some of the weaknesses of prior studies, including the lack of patient-level data on SCIP-adherence and standardized definition and abstraction of surgical-site-infection data.

The findings also are scheduled to appear in the September print issue of the Annals of Surgery.

Hawn’s co-authors on the paper are Catherine C. Vick, M.S.; Rhiannon J. Deierhoi, M.P.H.; and Laura A. Graham, M.P.H., with the Veterans Affairs Medical Center, Birmingham, Ala.; Joshua Richman, M.D., Ph.D., and William Holman, M.D., with UAB; William G. Henderson, M.P.H., Ph.D, with University of Colorado Denver; and Kamal M.F. Itani, M.D., Boston University and Harvard Medical School.