Prevention of Surgical Site Infections: Improving Compliance With the Surgical Care Improvement Project Measures

Keith M. Olsen, PharmD


July 14, 2009

In This Article

Introduction and Overview

About 30 million surgeries are performed in the United States each year, and despite the advances in surgical and anesthesia techniques and improvements in perioperative care, variations in outcomes continue to occur.[1] Patients with surgical site infections (SSIs) are 5 times more likely to be readmitted to the hospital, 60% more likely to be admitted to the intensive care unit (ICU), twice as likely to die, and are hospitalized 7 days longer on average than patients in whom SSIs do not develop.[2] Furthermore, SSIs may severely affect financial reimbursement. Dimick and colleagues[3] demonstrated that uncomplicated surgeries resulted in a 23% profit margin. A postoperative complication, such as infection, increased cost of care by over 54% with a resulting profit margin decreased to 3.4%.[3]

SSIs are the second most common type of adverse event occurring in hospitalized patients,[4] and an estimated 40% to 60% of these infections are thought to be preventable. Recently, the Centers for Medicare and Medicaid services created a list of hospital-acquired conditions that are non-reimbursable because they were deemed preventable.[5] These include SSIs following coronary artery bypass grafting, bariatric surgery, laparoscopic gastric bypass, gastroenterostomy, laparoscopic gastric restrictive surgery, and orthopedic procedures involving the spine, neck, shoulder, or elbow. Surgical societies raised concerns that underlying patient conditions and other factors can increase postoperative infection risks, but the Centers for Medicare and Medicaid services was not dissuaded from implementing the new rules.

These statistics and recent rule changes highlight the need to review factors important in preventing SSIs and measures designed to decrease surgical morbidity and mortality.