外科监护治疗的改良方案（英文PPT）The Surgical Care Improvement Project课件.ppt

The Surgical Care Improvement ProjectWhere we started and where we’re going… Why focus on surgical quality? ~30 million major operations each year in the US Despite advances in surgical and anesthesia technique and improvements in perioperative care, variations in outcomes for patients having surgery are well known Why focus on surgical quality Patients who experience a postoperative complication have dramatically increased hospital length of stay, hospital costs, and mortality On average, the length of stay for patients who have a postoperative complication is 3 to 11 days longer Consequences of Surgical Complications Dimick and colleagues demonstrated increased costs: infectious complications was $1,398 cardiovascular complications $7,789 respiratory complications $52,466 thromboembolic complications $18,310. Impact of Complications on Survival Who Pays for Surgical Complications? Medicare Surgical Infection Prevention (SIP) Project Objective To decrease the morbidity and mortality associated with postoperative infection in the Medicare patient population Risk Factors for SSI Risk Factors for SSI Quality IndicatorsNational Surgical Infection Prevention Project Proportion of patients with antibiotic initiated within 1 hour before surgical incision Proportion of patients who receive prophylactic antibiotics consistent with current recommendations Proportion of patients whose prophylactic antibiotics were discontinued within 24 hours of surgery end time Efficacy Of Prophylaxis Is Independent Of The Specific Antibiotic Timing of Antibiotic ProphylaxisGI Operations Perioperative AntibioticsTiming of Administration Discontinuation of Prophylaxis Numerous clinical trials have compared short-term to long-term antimicrobial prophylaxis Many compared single-dose prophylaxis to multiple dose prophylaxis Wide variety of operations using a wide variety of antimicrobial agents Infection rates are the same regardless of duration of prophylaxis Prolonged prophylax