Surgical Care^† Performance Detail 

What this information tells us

What’s important to know about surgical infection prevention

• In about 25 percent to 50 percent of operations, overuse, underuse, improper timing, and inappropriate use of antibiotics occur. ³⁴

• Overuse, underuse, inappropriate use, and improper timing of antibiotics could result in a surgical site infection, an increased risk of antibiotic resistance, an antibiotic shortage, and increased health care costs.

• Based on scientific evidence, health care personnel can take specific steps to prevent surgical site infections for some operations, including:

  • Selecting the antibiotics recommended by the Surgical Care Improvement Project ³³ specific to the type of surgery the patient is having.

  • Starting the preventive antibiotic within one hour of the first surgical skin cut (except for vancomycin or fluoroquinolone antibiotics, which should be given within two hours before the first surgical skin cut).

• Ways that the patient can prevent or minimize surgical infections are:

  • Stop smoking. Patients who smoke have significantly higher rates of surgical infections.

  • Wash your hands before touching your surgical site or any other open site, and ask that others do the same—including health care professionals. Hand washing is the single most important means of preventing infections.
    

Results

• In 2006, 881 Joint Commission-accredited hospitals reported data for this measure and achieved overall national average performance of 86.7 percent in providing surgical patients with antibiotics within one hour before the first surgical cut—an improvement of 4.9 percentage points from 2005, the first full year this measure set was tracked.

• Performance rates among the different types of surgical procedures ranged from 78.0 to 90.4 percent.

  • For coronary artery bypass graft (CABG) surgery, of the 282 hospitals reporting this data, 87.6 percent provided antibiotics within one hour before the first surgical cut—an improvement of 2.4 percentage points from 2005. Performance rates among states for this measure ranged from 61.8 to 100 percent.

  • For cardiac surgery (other than CABG), of the 275 hospitals reporting this data, 87.1 percent provided antibiotics within one hour before the first surgical cut—an improvement of 3.3 percentage points from 2005. Performance rates among states for this measure ranged from 50.0 to 100 percent.

  • For colon surgery, of the 828 hospitals reporting this data, 78.0 percent provided antibiotics within one hour before the first surgical cut—an improvement of 5.8* percentage points from 2005. Performance rates among states for this measure ranged from 59.3 to 100 percent.

  • For hip joint replacement surgery, of the 783 hospitals reporting this data, 86.8 percent provided antibiotics within one hour before the first surgical cut—an improvement of 5.5* percentage points from 2005. Performance rates among states for this measure ranged from 20.0 to 100 percent.

  • For hysterectomy surgery, of the 802 hospitals reporting this data, 87.0 percent provided antibiotics within one hour before the first surgical cut—an improvement of 4.7 percentage points from 2005. Performance rates among states for this measure ranged from 67.2 to 96.6 percent.

  • For knee joint replacement surgery, of the 779 hospitals reporting this data, 90.4 percent provided antibiotics within one hour before the first surgical cut—an improvement of 5.3* percentage points from 2005. Performance rates among states for this measure ranged from 50.0 to 100 percent.

  • For vascular surgery, of the 563 hospitals reporting this data, 81.1 percent provided antibiotics within one hour before the first surgical cut—an improvement of 5.9 percentage points from 2005. Performance rates among states for this measure ranged from 50.0 to 100 percent.  
    

What one should know about the data

• The smaller number of hospitals reporting on the surgical care measures may be a result of the majority of hospitals selecting the acute myocardial infarction, heart failure, and pneumonia measure sets to meet both Joint Commission requirements and receive a financial incentive from Medicare. Hospitals receiving reimbursement from Medicare had a financial incentive in 2006 to submit data on 21 measures from the acute myocardial infarction, heart failure and pneumonia measure sets, or receive a lower payment if not reported. However, as requirements and incentives change, it is anticipated that a larger number of hospital will select this measure set.

• Some surgical patients received an antibiotic within one hour before the first surgical cut but were excluded from these data for one or more of the following reasons:

  • The patient was taking antibiotics within 24 hours before arriving at the hospital or having surgery (except colon surgery patients taking oral antibiotics as directed by their doctor).

  • The patient was taking antibiotics more than 24 hours before surgery (except colon surgery patients taking oral antibiotics as directed by their doctor).

  • The patient was having colon surgery and was already taking oral antibiotics as directed by his or her doctor, and the patient received no other antibiotics during his or her hospital stay.

  • The patient had another procedure that required anesthesia, and the anesthesia was administered within 3 days (4 days for CABG and other cardiac surgery) before or after the surgery.

  • The patient’s surgery occurred before the date of admission.

  • The patient already had an infection or infectious disease.

  • The patient was younger than 18 years of age. 

What this information tells us

What’s important to know about surgical infection prevention

• Surgical site infections are not contagious and cannot be transferred from one person to another. However, these infections can have devastating effects on the patient and their families.

• Surgical site infections are the second most common hospital-acquired infections in the United States.³³

• Of 40 million operations performed in the United States annually, 0.8 million to 2 million are associated with surgical site infections.³⁴

• Surgical site infections prolong hospital stays by an average of 7.5 days. ³⁴

• Surgical site infections cost the nation between $130 million to $845 million each year. ³⁴

• It is estimated that 40 percent to 60 percent of surgical site infections could be prevented. ³⁴

• In about 25 percent to 50 percent of operations, overuse, underuse, improper timing, and inappropriate use of antibiotics occur. ³⁴

Results

• Joint Commission-accredited hospitals reported improvement during the course of the study for all of the surgical care measure related to providing antibiotics within one hour before surgery. The most significant improvement was for knee joint replacement surgery. 

• The best rates of performance for receiving antibiotics within one hour before surgery were for:

  • Knee joint replacement surgery improved from 85.1* percent in 2005 to 90.4 percent in 2006.

  • CABG surgery improved from 85.2 percent in 2005 to 87.6 percent in 2006.

  • Cardiac surgery improved from 83.8 in 2005 to 87.1 in 2006.

• The greatest need for improvement is for receiving antibiotics within one hour before colon surgery with 78.0 percent national performance.  

What one should know about the data

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Key to abbreviations: CABG: Coronary artery bypass graft surgery. See Glossary for definitions.

 

What this information tells us

These data report the percentage of surgical patients at Joint Commission-accredited hospitals throughout the nation whose antibiotic was stopped within 24 hours after having surgery (or within 48 hours of having CABG or other cardiac surgery). Giving medicine that prevents infection for more than 24 hours after the end of surgery is not helpful unless there is a specific reason (for example, fever or other signs of infection). This measure is one of two surgical care measures. Each measure reports the rates on seven specific surgical procedures, as well as the overall measure rate. The box plots show the 25^th, 50^th and 75^th percentile and the range of data (the “whiskers”) for each surgical procedure and for this measure overall. Note: Not every surgery requires antibiotics and this measure reports on those selected surgeries where evidence or experts have identified that antibiotics would be helpful.

 

What’s important to know about surgical infection prevention

• In about 25 percent to 50 percent of operations, overuse, underuse, improper timing, and inappropriate use of antibiotics occur. ³⁴

• Overuse, underuse, inappropriate use, and improper timing of antibiotics could result in a surgical site infection, an increased risk of antibiotic resistance, an antibiotic shortage, and increased health care costs.

• Based on scientific evidence, health care personnel can take specific steps to prevent surgical site infections for some operations, including:

  • Selecting the antibiotics recommended by the Surgical Infection Prevention Project³³ specific to the type of surgery the patient is having.

  • Stopping the preventive antibiotic within 24 hours after the surgery (48 hours for CABG or other cardiac surgery).

• Ways that the patient can prevent or minimize surgical infections are:

  • Stop smoking. Patients who smoke have significantly higher rates of surgical infections.

  • Wash your hands before touching your surgical site or any other open site, and ask that others do the same—including health care professionals. Hand washing is the single most important means of preventing infections. 

Results

• In 2006, 880 Joint Commission-accredited hospitals reported data for this measure and achieved overall national average performance of 78.9 percent in stopping antibiotics within 24 hours after surgery—an improvement of 5.4 percentage points from 2005, the first full year this measure set was tracked.
  
  
• Performance rates among the different types of surgical procedures ranged from 65.2 to 89.1 percent.
  
  
  • For coronary artery bypass graft (CABG) surgery, of the 282 hospitals reporting this data, 86.8 percent stopped antibiotics within 24 hours after surgery—an improvement of 16.8 percentage points from 2005. Performance rates among states for this measure ranged from 42.1 to 100 percent.
    
    
  • For cardiac surgery (other than CABG), of the 275 hospitals reporting this data, 85.7 percent stopped antibiotics within 24 hours after surgery—an improvement of 22.7 percentage points from 2005. Performance rates among states for this measure ranged from 50.0 to 100 percent.
    
    
  • For colon surgery, of the 826 hospitals reporting this data, 65.2 percent stopped antibiotics within 24 hours after surgery—an improvement of 3.7 percentage points from 2005. Performance rates among states for this measure ranged from 16.9 to 90.1 percent.
    
    
  • For hip joint replacement surgery, of the 782 hospitals reporting this data, 74.7 percent stopped antibiotics within 24 hours after surgery—an improvement of 5.7 percentage points from 2005. Performance rates among states for this measure ranged from 22.2 to 100 percent.
    
    
  • For hysterectomy surgery, of the 801 hospitals reporting this data, 89.1 percent stopped antibiotics within 24 hours after surgery—an improvement of 1.1 percentage points from 2005. Performance rates among states for this measure ranged from 67.9 to 100 percent.
    
    
  • For knee joint replacement surgery, of the 779 hospitals reporting this data, 76.0 percent stopped antibiotics within 24 hours after surgery—an improvement of 6.7 percentage points from 2005. Performance rates among states for this measure ranged from 37.8 to 100 percent. 
    
    
  •  For vascular surgery, of the 557 hospitals reporting this data, 67.2 percent stopped antibiotics within 24 hours after surgery—an improvement of 1.8 percentage points from 2005. Performance rates among states for this measure ranged from 25.0 to 100 percent.  
    

What one should know about the data

• The smaller number of hospitals reporting on the surgical care measures may be a result of the majority of hospitals selecting the acute myocardial infarction, heart failure, and pneumonia measure sets to meet both Joint Commission requirements and receive a financial incentive from Medicare. Hospitals receiving reimbursement from Medicare had a financial incentive in 2006 to submit data on 21 measures from the acute myocardial infarction, heart failure and pneumonia measure sets, or receive a lower payment if not reported. However, as requirements and incentives change, it is anticipated that a larger number of hospital will select this measure set. 

• Some surgical patients received an antibiotic within one hour before the first surgical cut but were excluded from these data for one or more of the following reasons:

  • The patient was taking antibiotics within 24 hours before arriving at the hospital or having surgery (except colon surgery patients taking oral antibiotics as directed by their doctor).

  • The patient was taking antibiotics more than 24 hours before surgery (except colon surgery patients taking oral antibiotics as directed by their doctor).

  • The patient was diagnosed and treated for infection within two days after surgery (three days for CABG and other cardiac surgery).

  • The patient did not receive any antibiotics during his or her hospital stay.

  • The patient had another procedure that required anesthesia, and the anesthesia was administered within 3 days (4 days for CABG and other cardiac surgery) before or after the surgery.

  • The patient’s surgery occurred before the date of admission.

  • The patient already had an infection or infectious disease.

  • The patient was younger than 18 years of age.  
    

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See Glossary for definitions.

 

What this information tells us

These graphs show the national performance, or compliance, rates of Joint Commission accredited hospitals from 2005 to 2006 for the surgical care measure on stopping antibiotics within 24 hours after surgery. The overall rate is shown as well as rates for the specific types of surgery.

 

What’s important to know about surgical infection prevention

• Surgical site infections are not contagious and cannot be transferred from one person to another. However, these infections can have devastating effects on the patient and their families.

• Surgical site infections are the second most common hospital-acquired infections in the United States.³³

• Of 40 million operations performed in the United States annually, 0.8 million to 2 million are associated with surgical site infections.³⁴

• Surgical site infections prolong hospital stays by an average of 7.5 days. ³⁴

• Surgical site infections cost the nation between $130 million to $845 million each year. ³⁴

• It is estimated that 40 percent to 60 percent of surgical site infections could be prevented. ³⁴

• In about 25 percent to 50 percent of operations, overuse, underuse, improper timing, and inappropriate use of antibiotics occur. ³⁴

Results

• Joint Commission-accredited hospitals reported improvement during the course of the study for all of the surgical care measure related to stopping antibiotics within 24 hours after the end of surgery. The most significant improvement was for hysterectomy surgery. 

• The best rates of performance for stopping antibiotics within 24 hours after surgery were for:

  • Hysterectomy surgery improved from 88.0 percent in 2005 to 89.1 percent in 2006.

  • CABG surgery improved from 70.0 percent in 2005 to 86.8 percent in 2006.

  • Cardiac surgery improved from 63.0 in 2005 to 85.7 in 2006.

• The greatest need for improvement is for stopping antibiotics within 24 hours after colon surgery with 65.2 percent national performance.
  

What one should know about the data

While improvement sometimes is less than 1 percentage point, these are statistically significant improvements because of the larger number of hospitals that reported these data during the time period covered in these graphs. 

 

* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data.

† In 2006, the Surgical Infection Prevention Project was renamed the Surgical Care Improvement Project to encompass more areas of surgical care.