S. Groene1, C. Chandrasekera1, T. Prasad1, A. Lincourt1, B. T. Heniford1, V. Augenstein1 1Carolinas Medical Center,Division Of Gastrointestinal And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction: The Surgical Care Improvement Project (SCIP) was instituted as a means to improve outcomes after surgery. One specific area of intended improvement was post-operative surgical site infections (SSI). The aim of this study was to compare the outcomes in colorectal patients who received antibiotics per SCIP guidelines versus those that did not.
Methods: A list of 44 patients at our institution where SCIP antibiotic measures were not followed between 2012-2014 was obtained. Twelve of these patients were in our NSQIP database and we used the results from NSQIP to determine demographics, pre-op co-morbidities and post-op outcomes. For the other 32 patients, a chart review was conducted to determine similar variables. We also excluded any NSQIP patients with sepsis or dirty wounds as they met SCIP exclusion criteria. Standard statistical methods were used to compare the data for the 44 non-compliant patients to the remaining SCIP-compliant patients in the NSQIP database.
Results: There were 563 patients in the sample and 44 did not receive antibiotics per SCIP guidelines. Of these 44 patients, 3 did not receive SCIP appropriate pre-op dosing of antibiotics within 1 hour of incision, 25 did not receive the SCIP appropriate antibiotic and 16 were non-compliant with post-op antibiotic duration. There were no significant differences between the groups in age, BMI, race, gender, hypertension, heart failure, ASA class, or ventilator use. There were no significant differences in superficial SSI, deep incisional SSI, organ space infection, pneumonia, UTIs, DVT/PEs, MIs, post-op transfusions or sepsis, unplanned return to the OR, 30 day mortality or length of stay between the 2 groups. Those in the non-adherent group had higher rates of pre-op diabetes (27.3% vs 15%; p=0.03), COPD (15.9% vs 5.2%; p=0.003) and pre-op renal failure (9.1% vs 0.2%; p<0.001). Post-operatively, those who were not SCIP adherent had higher rates of acute renal failure (6.8% vs 0.2%; p=0.002), unplanned intubations (9.1% vs 2.1%; p=0.02) and deaths after 30 days (4.6% vs 0.4%; p=0.03).
Conclusion: Overall, colorectal patients who were non-compliant with SCIP antibiotic measures had higher rates of diabetes, COPD and pre-op renal failure. They also had higher rates of post-op renal failure, unplanned intubations and death after 30 days. However, there were no differences in infectious outcomes between the groups, which may suggest that SCIP non-compliance with antibiotic measures may not lead to clinically significant differences in infectious outcomes.