Scott Andrew V, Stonemetz Jerry L, Wasey Jack O, Johnson Daniel J, Rivers Richard J, Koch Colleen G, Frank Steven M
From the Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
Anesthesiology. 2015 Jul;123(1):116-25. doi: 10.1097/ALN.0000000000000681.
In an effort to measure and improve the quality of perioperative care, the Surgical Care Improvement Project (SCIP) was introduced in 2003. The SCIP guidelines are evidence-based process measures designed to reduce preventable morbidity, but it remains to be determined whether SCIP-measure compliance is associated with improved outcomes.
The authors retrospectively analyzed the electronic medical record data from 45,304 inpatients at a single institution to assess whether compliance with SCIP Inf-10 (body temperature management) was associated with a reduced incidence of morbidity and mortality. The primary outcomes were hospital-acquired infection and ischemic cardiovascular events. Secondary outcomes were mortality and hospital length of stay.
Body temperature on admission to the postoperative care unit was higher in the SCIP-compliant group (36.6° ± 0.5°C; n = 44,064) compared with the SCIP-noncompliant group (35.5° ± 0.5°C; n = 1,240) (P < 0.0001). SCIP compliance was associated with improved outcomes in both nonadjusted and risk-adjusted analyses. SCIP compliance was associated with a reduced incidence of hospital-acquired infection (3,312 [7.5%] vs.160 [12.9%] events; risk-adjusted odds ratio [OR], 0.68; 95% CI, 0.54 to 0.85), ischemic cardiovascular events (602 [1.4%] vs. 38 [3.1%] events; risk-adjusted OR, 0.60; 95% CI, 0.41 to 0.92), and mortality (617 [1.4%] vs. 60 [4.8%] events; risk-adjusted OR, 0.41; 95% CI, 0.29 to 0.58). Median (interquartile range) hospital length of stay was also decreased: 4 (2 to 8) versus 5 (2 to 14) days; P < 0.0001.
Compliance with SCIP Inf-10 body temperature management guidelines during surgery is associated with improved clinical outcomes and can be used as a quality measure.
为了衡量和提高围手术期护理质量，2003年引入了外科护理改进项目（SCIP）。SCIP指南是基于证据的过程指标，旨在减少可预防的发病率，但SCIP指标的依从性是否与改善的结果相关仍有待确定。
作者回顾性分析了一家机构45304名住院患者的电子病历数据，以评估遵守SCIP Inf-10（体温管理）是否与发病率和死亡率的降低相关。主要结局是医院获得性感染和缺血性心血管事件。次要结局是死亡率和住院时间。
术后护理单元入院时，符合SCIP的组（36.6°±0.5°C；n = 44064）体温高于不符合SCIP的组（35.5°±0.5°C；n = 1240）（P < 0.0001）。在未调整和风险调整分析中，SCIP依从性均与改善的结局相关。SCIP依从性与医院获得性感染发生率降低相关（3312例[7.5%]对160例[12.9%]；风险调整比值比[OR]，0.68；95%CI，0.54至0.85）、缺血性心血管事件（602例[1.4%]对38例[3.1%]；风险调整OR，0.60；95%CI，0.41至0.92）和死亡率（617例[1.4%]对60例[4.8%]；风险调整OR，0.41；95%CI，0.29至0.58）。住院时间中位数（四分位间距）也缩短了：4（2至8）天对5（2至14）天；P < 0.0001。
手术期间遵守SCIP Inf-10体温管理指南与改善临床结局相关，可作为一项质量指标。
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