Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Abstract

Background Guidelines recommend discontinuation of antimicrobial prophylaxis within 24 h after incision closure in uninfected patients. However, how facility and surgical specialty factors affect the implementation of these evidence-based surgical prophylaxis guidelines in outpatient surgery is unknown. Thus, we sought to measure how facility complexity, including ambulatory surgical center (ASC) status and availability of ancillary services, impact adherence to guidelines for timely discontinuation of antimicrobial prophylaxis after outpatient surgery. A secondary aim was to measure the association between surgical specialty and guideline compliance. Methods A multi-center, national Veterans Health Administration retrospective cohort from 10/1/2015–9/30/2017 including any Veteran undergoing an outpatient surgical procedure in any of five specialties (general surgery, urology, ophthalmology, ENT, orthopedics) was created. The primary outcome was the association between facility complexity and proportion of surgeries not compliant with discontinuation of antimicrobials within 24 h of incision closure. Data were analyzed using logistic regression with adjustments for patient and procedural factors. Results Among 153,097 outpatient surgeries, 7712 (5.0%) received antimicrobial prophylaxis lasting > 24 h after surgery; rates ranged from 0.4% (eye surgeries) to 13.7% (genitourinary surgeries). Cystoscopies and cystoureteroscopy with lithotripsy procedures had the highest rates (16 and 20%), while hernia repair, cataract surgeries, and laparoscopic cholecystectomies had the lowest (0.2–0.3%). In an adjusted logistic regression model, lower complexity ASC and hospital outpatient departments had higher odds of prolonged antimicrobial prophylaxis compared to complex hospitals (OR ASC, 1.3, 95% CI: 1.2–1.5). Patient factors associated with higher odds of noncompliance with antimicrobial discontinuation included younger age, female sex, and white race. Genitourinary and ear/nose/throat surgeries were associated with the highest odds of prolonged antimicrobial prophylaxis. Conclusions Facility complexity appears to play a role in adherence to surgical infection prevention guidelines. Lower complexity facilities with limited infection prevention and antimicrobial stewardship resources may be important targets for quality improvement. Such interventions may be especially useful for genitourinary and ear/nose/throat surgical subspecialties. Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ambulatory surgery centers and hospital outpatient departments in their efforts to improve this facet of patient safety. Electronic supplementary material The online version of this article (10.1186/s13756-019-0503-9) contains supplementary material, which is available to authorized users. ...

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital

“…Furthermore, all women, including those who did not receive PAP, received post-surgical antibiotic treatment, something which is non-compliant with the guidelines recommendations. This is the most relevant result of the study and is consistent with that obtained by Saied et al in Egypt [17]. Other studies have also shown the inappropriate duration of PAP and the use of different therapeutic schemes that are poorly described and unnecessary [7,8,15,18,19].…”

“…This is the most relevant result of the study and is consistent with that obtained by Saied et al in Egypt [ 17 ]. Other studies have also shown the inappropriate duration of PAP and the use of different therapeutic schemes that are poorly described and unnecessary [ 7 , 8 , 15 , 18 , 19 ]. Patients who suffered a loss of blood greater than 1.5 L or who had prolonged surgery (more than 4 h), received prophylaxis for approximately 7 days, just like the rest of patients, which is in contradiction to what was stated in the literature [ 11 , 14 , 15 ].…”

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

“…This is the most relevant result of the study and is consistent with that obtained by Saied et al in Egypt [19]. Other studies have also shown the inappropriate duration of PAP and the use of different therapeutic schemes that are poorly described and unnecessary [7,20]. In patients with blood loss greater than 1.5 L or who had prolonged surgery (more than 4 h) the duration of prophylaxis, as in the rest of the patients, was approximately 7 days, in contrast to what was stated in the literature [12,16,17].…”

Prolonged postprocedural antimicrobial use: A survey of the Society for Healthcare Epidemiology of America Research Network

“…A prior study found that smaller hospitals with resource limitations had greater difficulty translating surgical site infection guidelines into local practice. 8 However, we found that >25% of the largest hospitals (>500 beds) had not yet adopted a shorter duration of SAP in their policies, which suggests that barriers to guideline implementation may extend beyond hospital size and complexity.…”