Background: In the late 1990’s the quality of health care was questioned in two landmark publications, To Err is Human and Crossing the Quality Chasm. Concern about the errors in delivering health care became such a bellwether issue that the Centers for Medicare & Medicaid Services instituted the Surgical Care Improvement Project (SCIP) in 2001 to standardize core measures to improve patient care. The requirement to deliver appropriate antibiotics in a timely fashion and to discontinue postoperatively was one of the first of the SCIP initiatives.

Methods: To determine what impact this program has had on the rates of postoperative surgical infections (POSI) the National Inpatient Sample database was used to evaluate infections in adult patients (age ≥ 18 years old) for elective cholecystectomies (open: n=19,706; laparoscopic: n=72,920) and elective colectomies (n=90,596) from the years 2001 through 2006. Annual infection rates were determined for each of the operations. Mortality rates and length of stay (LOS) were also assessed.

Results: Postoperative infections increased in colon surgery steadily from 2.60% in 2001, to 2.68% in 2002, to 2.87% in 2003, to 2.99% in 2004, to 3.23% in 2005, and to 4.27% in 2006. This rise in infection was statistically significantly (p<0.0001). An increase in POSI from 2001 to 2006 was seen in open cholecystectomies surgery from 1.13% in 2001 to 1.94% in 2006 (p=0.01) and in laparoscopic cholecystectomies from 0.28% in 2001 to 0.55 % in 2006 (p=0.001). LOS was significantly increased in infected compared to noninfected patients for all three groups (p<0.0001).

Conclusion: The growing infection rates documented in this study may be due to many reasons rather than noncompliance with the SCIP protocol. These include: 1) a rise in the reporting of infections, 2) a true increase in the infection rate, 3) a weakness of the database, or 4) a problem with SCIP.