Optimal timing of surgical antimicrobial prophylaxis in laparoscopic surgery: a before-after study

Takamatsu, Akane; Tagashira, Yasuaki; Ishii, Kaori; Morita, Yasuhiro; Tokuda, Yasuharu; Honda, Hitoshi

doi:10.1186/s13756-018-0424-z

Cited by 2 publications

(3 citation statements)

References 18 publications

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“…27 From an organizational perspective, it has been shown that the completion of SAP administration was greater than 98%, and, therefore, very reliable if given immediately after entering the operating room. 15 Although our primary exposure variable was the exact timing of SAP administration, our data confirm findings from many previous studies [4][5][6]20,21,28 that other confounders are significantly associated with SSI risk: higher ASA score, clean-contaminated wound classes (vs clean), and surgical procedures exceeding standard time were associated with an increased risk, as shown elsewhere.…”

Section: Principal Findingssupporting

confidence: 87%

“…Our main results indicating administration of SAP close to the time incision are supported by pharmacokinetic data showing mean serum concentration peaks already 3 minutes after intravenous cefuroxime administration and a half-life of 30 minutes . From an organizational perspective, it has been shown that the completion of SAP administration was greater than 98%, and, therefore, very reliable if given immediately after entering the operating room …”

Section: Discussionsupporting

confidence: 74%

“…The findings of the study 14 did not support any narrowing of the 60-minute window for the administration of a cephalosporin with a short half-life. SAP administration immediately upon entering the operating room could also be beneficial; a before-after study 15 suggested that the number of patients without completion of SAP prior to surgical incision decreased significantly from 16.8% to 1.8% if SAP was administered immediately after the patients entered the operating room. The aim of this cohort study was, therefore, to assess whether the timing of administration (ie, at 61-120 minutes vs at 31-60 minutes vs at 0-30 minutes) of cefuroxime SAP was associated with different rates of SSI, and, in addition, whether administration of SAP after the patient is transferred to the operating room (10-25 minutes before incision) is an optimal administration time.…”

Section: Introductionmentioning

confidence: 99%

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Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections

et al. 2023

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ImportanceWorld Health Organization guidelines recommend administering surgical antimicrobial prophylaxis (SAP), including cefuroxime, within 120 minutes prior to incision. However, data from clinical settings supporting this long interval is limited.ObjectiveTo assess whether earlier vs later timing of administration of cefuroxime SAP is associated with the occurrence of surgical site infections (SSI).Design, Setting, and ParticipantsThis cohort study included adult patients who underwent 1 of 11 major surgical procedures with cefuroxime SAP, documented by the Swissnoso SSI surveillance system between January 2009 and December 2020 at 158 Swiss hospitals. Data were analyzed from January 2021 to April 2023.ExposuresTiming of cefuroxime SAP administration before incision was divided into 3 groups: 61 to 120 minutes before incision, 31 to 60 minutes before incision, and 0 to 30 minutes before incision. In addition, a subgroup analysis was performed with time windows of 30 to 55 minutes and 10 to 25 minutes as a surrogate marker for administration in the preoperating room vs in the operating room, respectively. The timing of SAP administration was defined as the start of the infusion obtained from the anesthesia protocol.Main Outcomes and MeasuresOccurrence of SSI according to Centers for Disease Control and Prevention definitions. Mixed-effects logistic regression models adjusted for institutional, patient, and perioperative variables were applied.ResultsOf 538 967 surveilled patients, 222 439 (104 047 men [46.8%]; median [IQR] age, 65.7 [53.9-74.2] years), fulfilled inclusion criteria. SSI was identified in 5355 patients (2.4%). Cefuroxime SAP was administered 61 to 120 minutes prior to incision in 27 207 patients (12.2%), 31 to 60 minutes prior to incision in 118 004 patients (53.1%), and 0 to 30 minutes prior to incision in 77 228 patients (34.7%). SAP administration at 0 to 30 minutes was significantly associated with a lower SSI rate (adjusted odds ratio [aOR], 0.85; 95% CI, 0.78-0.93; P &lt; .001), as was SAP administration 31 to 60 minutes prior to incision (aOR, 0.91; 95% CI, 0.84-0.98; P = .01) compared with administration 61 to 120 minutes prior to incision. Administration 10 to 25 minutes prior to incision in 45 448 patients (20.4%) was significantly associated with a lower SSI rate (aOR, 0.89; 95% CI, 0.82-0.97; P = .009) vs administration within 30 to 55 minutes prior to incision in 117 348 patients (52.8%).Conclusions and RelevanceIn this cohort study, administration of cefuroxime SAP closer to the incision time was associated with significantly lower odds of SSI, suggesting that cefuroxime SAP should be administrated within 60 minutes prior to incision, and ideally within 10 to 25 minutes.

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