Cost‐benefit analysis of cephradine and mezlocillin prophylaxis for abdominal and vaginal hysterectomy

Abstract

Summary. Four hundred patients (300 abdominal and 100 vaginal hysterectomies) were randomized to receive a single, pre‐operative intravenous injection of saline (placebo), 2 g cephradine or 5 g mezlocillin. The frequency of wound and pelvic infections was significantly reduced (P<0.05, χ2‐ or Fisher's exact test) in the abdominal hysterectomy patients who received cephradine (16% vs 23% mezlocillin, 29% placebo) and in the vaginal hysterectomy patients who received cephradine or mezlocillin (0% mezlocillin, 6% cephradine vs 27% placebo). These results are similar to those of previous studies and suggest that prophylaxis is more effective for vaginal than for abdominal hysterectomy. However, a cost‐benefit analysis supported the opposite conclusion. Cephradine prophylaxis for abdominal hysterectomy resulted in cost savings to the hospital and the community health services with measurable benefits to the patient. In contrast, cephradine or mezlocillin prophylaxis for vaginal hysterectomy resulted in increased costs to the hospital, no savings to community services and no significant benefit to the patient. We conclude that cost‐benefit analysis provided valuable additional information to the conventional, statistical analysis of wound or pelvic infection rates.

Systematic review of the cost-effectiveness of preoperative antibiotic prophylaxis in reducing surgical-site infection

“…Table provides detailed characteristics of the 12 included studies. These were published between 1988 and 2014 with four published after 2000 , .…”

“…Nine 36–38,40–45 were RCTs, two were nested within an RCT and one was a retrospective chart review. Eight were conducted in Europe (Greece , Scotland, UK, Spain, Italy, Finland and the Netherlands), three in the USA , and one in Japan. The studies encompassed head and neck, gynaecological, vascular, cardiothoracic, general (breast and endocrine, intestinal and colorectal, and hepatopancreatobiliary) and orthopaedic surgery.…”

“…Eleven studies 35–38,40–46 evaluated the effectiveness of preoperative prophylaxis of the antibiotic cephalosporin (either first, second or third generation). These included ‘clean’ surgery (neck dissection, axillary lymph node dissection, coronary artery bypass graft (CABG) , abdominal aortic or lower limb prosthetic vascular surgery) and ‘clean‐contaminated’ surgery (abdominal or vaginal hysterectomy , , digestive tract resection with anastomosis, colonic resection and colorectal surgery , biliary and gallbladder surgery). One study evaluated selective decontamination of the digestive tract in clean‐contaminated surgery of the digestive tract with anastomosis.…”

“…Only one study had a high reporting quality for 18 of the 22 items. Three studies reported economic evaluations in their titles. In most studies the objectives, methods (settings, populations and comparators) were well reported , , although time horizons and discounting were poorly reported , .…”

“…In most studies the objectives, methods (settings, populations and comparators) were well reported , , although time horizons and discounting were poorly reported , . Overall the results were poorly reported, including study parameters, incremental costs and characterization of uncertainty and heterogeneity. Discussion around the individual study findings, their limitations and generalizability was also of poor quality .…”