Compliance with Surgical Care Improvement Project Measures and Hospital-Associated Infections Following Hip Arthroplasty

Background: Hospital compliance with the Surgical Care Improvement Project (SCIP) measures has increased recently for patients undergoing hip arthroplasty. However, reductions in postoperative infections were less than expected, and concern remains about complications associated with prophylaxis against venous thromboembolism (VTE). We sought to examine the association between hospital adherence to SCIP measures and postoperative infections.

Methods: We conducted an observational study of 17,714 patients who underwent hip replacement in 2008 at 128 New York state hospitals. These hospitals were divided into less compliant and highly compliant groups, on the basis of their levels of compliance compared with the median value of compliance with SCIP measures. From the New York State Department of Health annual report, we collected the confirmed postoperative infections at the facility level. From the Healthcare Cost and Utilization Project state inpatient database, we identified incidences of postoperative infections at the patient level, using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes.

Results: During 2008, mean hospital compliance increased from 93.5% to 96.0% for the infection prevention measure and from 91.4% to 97.5% for the VTE prevention measure. Higher adherence to infection prevention measures was not associated with a significant reduction in infection (p ≥ 0.09 for all). Hospitals that were at least 97% compliant with the SCIP VTE-2 measure (patients receiving VTE prophylaxis around the time of surgery) reported significantly higher infection rates compared with less compliant hospitals (1.60% versus 0.93%; p < 0.001). Similarly, patients from highly compliant hospitals (for the VTE-2 measure) were at significant risk of postoperative infection (adjusted odds ratio, 1.50; 95% confidence interval, 1.07 to 2.12; p = 0.02).

Conclusions: Targeting complete compliance with SCIP infection prevention measures was not associated with additional reductions in infection outcomes following hip replacement. Furthermore, significant risk of postoperative infections may result from increased perioperative use of VTE prophylactics.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.