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October 20, 2010

Surgical Care Improvement Project Adherence and Postoperative Infections

JAMA. 2010;304(15):1669-1672. doi:10.1001/jama.2010.1459

To the Editor: Dr Stulberg and colleagues1 examined the association between Surgical Care Improvement Project (SCIP) adherence and postoperative infections. Given differences between the trial data cited and the observational data presented, additional clarification of patient exclusions and modeling may inform study interpretation.

The authors did not present data describing the SCIP composition of S-INF adherent patients (ie, patients with at least 2 recorded SCIP infection-prevention measures), specifically which 2 reported measures were most common. In addition, 30% of all patients lacked data describing at least 2 reported SCIP infection-prevention measures and were excluded from the test of association between S-INF adherence (a composite measure) and postoperative infection. Patient characteristics may have differed between those with vs those without at least 2 reported measures, leading to a spurious result for the association between S-INF and postoperative infection.