http://archsurg.jamanetwork.com/ en-us Sat, 01 Dec 2012 00:00:00 GMT Tue, 01 Jan 2013 00:52:49 GMT Silverchair editor@archsurg.jamanetwork.com webmaster@archsurg.jamanetwork.com http://archsurg.jamanetwork.com/article.aspx?articleID=1380439 Mon, 01 Oct 2012 00:00:00 GMT Sicklick JK. <span class="paragraphSection">In 2005, the US Congress passed the Deficit Reduction Act, and in February 2006, it became law. The Deficit Reduction Act was designed to save almost $40 billion over 5 years by slowing the growth of spending for the Centers for Medicare & Medicaid Services (CMS) and other mandatory spending programs. In 2003, the Surgical Care Improvement Project (SCIP) partnership was initiated by the CMS and the Centers for Disease Control and Prevention to develop a national campaign to reduce surgical mortality and morbidity. The SCIP took effect in August 2005 and is coordinated through a steering committee of 10 national organizations and is advised by more than 20 additional organizations. In alignment with the goals of the Deficit Reduction Act, the goal of SCIP was to reduce the national incidence of postoperative complications by 25% by 2010. Allying the financial goals of the US government and the patient-orientated goals of the SCIP, the CMS was ordered to withhold additional hospital payments for 13 hospital-acquired complications developed during a hospital stay (Table). Included in this list are “preventable” complications, such as catheter-associated urinary tract infections (UTIs), which may be avoided with adherence to evidence-based guidelines. Such endeavors have affected the health of patients and medical centers around the United States.</span> 147 10 953 954 10.1001/archsurg.2012.1502 http://archsurg.jamanetwork.com/article.aspx?articleID=1380439 http://archsurg.jamanetwork.com/article.aspx?articleID=1380450 Mon, 01 Oct 2012 00:00:00 GMT Owen RM, Perez SD, Bornstein WA, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>The Surgical Care Improvement Project (SCIP) Inf-9 guideline promotes removal of indwelling urinary catheters (IUCs) within 48 hours of surgery.<div class="boxTitle">Objectives</div>To determine whether a correlation exists between SCIP Inf-9 compliance and postoperative urinary tract infection (UTI) rates and whether an association exists between UTI rates and SCIP Inf-9 exemption status.<div class="boxTitle">Design</div>Retrospective case control study.<div class="boxTitle">Setting</div>Southeastern academic medical center.<div class="boxTitle">Patients</div>American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and SCIP Inf-9 compliance data were collected prospectively on randomly selected general and vascular surgery inpatients. Monthly UTI rates and SCIP Inf-9 compliance scores were tested for correlation. Complete NSQIP data for all the inpatients with postoperative UTIs were compared with a group of 100 random controls to determine whether an association exists between UTI rates and SCIP Inf-9 exemption status.<div class="boxTitle">Main Outcome Measure</div>Postoperative UTI.<div class="boxTitle">Results</div>In 2459 patients reviewed, SCIP Inf-9 compliance increased over time, but this was not correlated with improved monthly UTI rates. Sixty-one of the 69 UTIs (88.4%) were compliant with SCIP Inf-9; however, 49 (71.0%) of these were considered exempt from the guideline and, therefore, the IUC was not removed within 48 hours of surgery. Retrospective review of 100 random controls showed a similar compliance rate (84.0%, P = .43) but a lower rate of exemption (23.5%, P < .001). The odds of developing a postoperative UTI were 8 times higher in patients deemed exempt from SCIP Inf-9 (odds ratio [OR], 7.99; 95% CI, 3.85-16.61). After controlling for differences between the 2 groups, the adjusted ORs slightly increased (OR, 8.34; 95% CI, 3.70-18.76).<div class="boxTitle">Conclusions</div>Most UTIs occurred in patients deemed exempt from SCIP Inf-9. Although compliance rates remain high, practices are not actually improving. Surgical Care Improvement Project Inf-9 guidelines should be modified with fewer exemptions to facilitate earlier removal of IUCs.</span> 147 10 946 953 10.1001/archsurg.2012.1485 http://archsurg.jamanetwork.com/article.aspx?articleID=1380450