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An Increase in Compliance With the Surgical Care Improvement Project Measures Does Not Prevent Surgical Site Infection in Colorectal Surgery

Pastor, Carlos M.D.1; Artinyan, Avo M.D.1; Varma, Madhulika G. M.D.2; Kim, Edward M.D.2; Gibbs, Laurel M.T.3; Garcia-Aguilar, Julio M.D., Ph.D.1

Diseases of the Colon & Rectum: January 2010 - Volume 53 - Issue 1 - p 24-30
doi: 10.1007/DCR.0b013e3181ba782a
Original Contribution

PURPOSE: The primary goal of the Surgical Care Improvement Project is to improve quality of care by implementing evidence-based health care practices that prevent surgical complications. This study was designed to test the hypothesis that an increase in compliance with quality process measures decreases the rate of surgical site infections in patients undergoing colorectal surgeries.

METHODS: A multidisciplinary task force implemented and monitored compliance with individual quality measures in patients undergoing elective colorectal resections at a tertiary institution. Individual compliance rates and infections were collected prospectively and reviewed monthly. For data analysis, patients were assigned to 2 consecutive 14-month periods: period A (April 1, 2006 to May 31, 2007) and period B (June 1, 2007 to July 31, 2008). Comparisons between periods were performed to determine the association of compliance with process measures and outcomes in infections.

RESULTS: A total of 491 consecutive patients were treated during the study periods (period A: n = 238; period B: n = 253). There were no statistically significant differences in patient characteristics, diagnoses, or surgical procedures between periods. Compliance with all process measures significantly increased within periods except for perioperative glucose control. Global compliance (compliance with all measures per patient) significantly improved from period A to B (40%–68%, respectively; P < .001). In total, 99 patients (19%) developed surgical site infections (period A, 18.9%; period B, 19.4%).

CONCLUSION: An increase in compliance with the Surgical Care Improvement Project aimed to prevent surgical site infections does not translate into a significant reduction of surgical site infections in patients undergoing colorectal resections.

1 Department of Surgery, City of Hope National Medical Center, Duarte, California

2 Department of Surgery, Section of Colorectal Surgery, University of California, San Francisco, San Francisco, California

3 Department of Infection Control, University of California, San Francisco, San Francisco, California

Financial Disclosure: None reported.

Presented at the meeting of The American Society of Colon and Rectal Surgeons, Hollywood, FL, May 2 to 6, 2009.

Correspondence: Julio Garcia-Aguilar M.D., Ph.D., Department of Surgery, City of Hope National Medical Center., 1500 East Duarte Rd., Duarte, CA 91010. E-mail: jgarcia-aguilar@coh.org

© The ASCRS 2010