The Surgical Care Improvement Project (SCIP) Initiative to Reduce Infection in Elective Colorectal Surgery: Which Performance Measures Affect Outcome? NHIEN NGUYEN, M.D., SARA YEGIYANTS, M.D., CAROLYN KALOOSTIAN, B.S., MAHER A. ABBAS, M.D., L. ANDREW DIFRONZO, M.D. From Kaiser Permanente Los Angeles Medical Center, Department of Surgery, Los Angeles, California One component of the Surgical Care Improvement Project (SCIP) is the prevention of surgical site infections (SSIs) by: 1) timing the administration of prophylactic antibiotics (PAs) within 1 hour of incision; 2) using approved PA regimens; and 3) discontinuing PA within 24 hours. We sought to evaluate institutional compliance with SCIP recommendations in patients undergoing elective colorectal surgery and determine whether they affected the incidence of SSI. One hundred four elective colorectal cases were reviewed. In 58 patients (56%), PAs were administered within 1 hour of incision. In 71 cases (68%), the PA choice was considered compliant. There were a total of 12 SSIs (11.5%) overall. The incidence of SSI was significantly higher in cases in which PAs were not administered within 1 hour of incision (10 of 46 or 22% vs two of 58 or 3.5%, P = 0.005). There was no significant difference in the incidence of SSI in patients who received compliant versus noncompliant PA (12.7% vs 9.1%, P = 0.75). Timely PA administration significantly reduces the incidence of SSI in patients undergoing elective colorectal surgery. Efforts should focus on en- suring that PAs are given in a timely manner to reduce SSI in colorectal surgery. S URGICAL SITE INFECTIONS (SSI) are one of the most common causes of postoperative morbidity and mortality in surgical patients. The National Nosoco- mial Infections Surveillance System, a national data- base reporting nosocomial infection surveillance data from the Centers for Disease Control and Prevention (CDC), estimates an overall 2.73 per cent rate of SSI among all surgical procedures. 1 Patients with SSIs are 60 per cent more likely to spend time in the intensive care unit, experience twice the mortality rate, have a greater median length of stay, and are five times more likely to be readmitted to the hospital. 2 To this end, the Surgical Care Improvement Project (SCIP) is a healthcare initiative aimed at reducing sur- gical morbidity and mortality. The initiative, from a joint national committee working in conjunction with the CDC and Centers for Medicare and Medicaid Ser- vices, is aimed at aspects of care associated with the most common surgical complications. One component of the project is aimed at the prevention of SSIs by adhering to three principles: 1) timely administration of prophylactic antibiotics (PAs) within 1 hour of in- cision; 2) use of specific PA regimens; and 3) discon- tinuation of PAs after within 24 hours postoperatively. The importance of timely PA antibiotic administra- tion has certainly been demonstrated with early and late PA administration associated with higher rates of SSI. 3 The data regarding compliance with specific PA regimens have been more controversial. The SCIP rec- ommendations regarding PA regimens are constantly evolving in light of fluctuating consensus. 4 In May 2007, our institution instituted new policies to improve compliance with the SCIP guidelines. In this study, we sought to examine our compliance with SCIP PA guidelines and to determine whether adher- ence to each guideline individually resulted in an im- provement in the incidence of SSIs. Methods We undertook a retrospective cohort study of all adult elective colorectal general surgical cases from July 2006 to July 2007. Patient age, gender, American Presented at the 19th Annual Scientific Meeting of the Southern California Chapter of the American College of Surgeons in Santa Barbara, CA, January 18–20, 2008. Address correspondence and reprint requests to L. Andrew Di- Fronzo, M.D., Kaiser Permanente Los Angeles Medical Center, 4760 Sunset Boulevard, Los Angeles, CA 90027. E-mail Andrew.L.Difronzo@kp.org. 1012