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Invited Critique
Oct 2012

Have We Hit an Invisible Barrier for Preventing Postoperative Urinary Tract Infections?Comment on “Impact of Surgical Care Improvement Project Inf-9 on Postoperative Urinary Tract Infections”

Author Affiliations

Author Affiliation: Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, San Diego, La Jolla.

Arch Surg. 2012;147(10):953-954. doi:10.1001/archsurg.2012.1502

In 2005, the US Congress passed the Deficit Reduction Act, and in February 2006, it became law.1 The Deficit Reduction Act was designed to save almost $40 billion over 5 years by slowing the growth of spending for the Centers for Medicare & Medicaid Services (CMS) and other mandatory spending programs. In 2003, the Surgical Care Improvement Project (SCIP) partnership was initiated by the CMS and the Centers for Disease Control and Prevention to develop a national campaign to reduce surgical mortality and morbidity.2 The SCIP took effect in August 2005 and is coordinated through a steering committee of 10 national organizations and is advised by more than 20 additional organizations. In alignment with the goals of the Deficit Reduction Act, the goal of SCIP was to reduce the national incidence of postoperative complications by 25% by 2010. Allying the financial goals of the US government and the patient-orientated goals of the SCIP, the CMS was ordered to withhold additional hospital payments for 13 hospital-acquired complications developed during a hospital stay (Table).3 Included in this list are “preventable” complications, such as catheter-associated urinary tract infections (UTIs), which may be avoided with adherence to evidence-based guidelines. Such endeavors have affected the health of patients and medical centers around the United States.

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