HIRA Quality Assessment Programme

The Korean QA system applied standardised prophylaxis rules without accounting for individual patient risk variables. Tertiary hospitals had the highest compliance with antibiotic guidelines yet also had the highest adjusted SSI risk, creating a paradox explained by their more complex and sicker patient populations. HIRA conducted nine quality assessment waves from 2007 to 2020, four of which included elective spinal surgeries. The ninth QA wave changed prophylaxis from a flexible policy to a uniform, narrow, and time-limited approach compared with earlier waves. The study was a nationwide retrospective cohort using HIRA quality assessment data linked to national health insurance claims data.