Outcomes/Effectiveness Research

Prophylactic antibiotics given to prevent surgical site infections are more timely if given in the operating room

Patients who suffer from surgical site infections (SSIs) have twice the mortality, are 60 percent more likely to spend time in an intensive care unit, and are five times more likely to be readmitted to the hospital than patients without SSIs. From 40 to 60 percent of SSIs are estimated to be preventable with proper administration of prophylactic antibiotics (PA). However, the practice of giving patients PA on the inpatient ward before operations is not as timely as PA given in the operating room.

Among patients undergoing major surgical procedures at 108 Veterans Affairs hospitals in 2005, timely PA occurred in 76.2 percent of patients. However, 18.2 percent of patients received antibiotics too early, and 5.4 percent received them too late.

Timely PA is administration of PA within 60 minutes before incision (120 minutes for vancomycin and fluoroquinolone antibiotics due to longer infusion times). PA administration occurred in the operating room for 63.5 percent of patients. When patients received PA in the operating room, they were timely in 89 percent of patients compared with 54 percent of patients who received PA outside the operating room.

The researchers examined PA administration to patients undergoing cardiac, hip and knee arthroplasty, colon, arterial vascular, and hysterectomy procedures. They observed differences in PA timeliness, which varied by procedure type (from 68 to 87 percent), admission status (67 to 80 percent), and antibiotic class (65 to 89 percent).

For example, patients who received vancomycin as the PA were more likely to receive timely antibiotics than those who received another antibiotic (88.8 vs. 72.8 percent), perhaps because of the 2-hour infusion window for vancomycin.

Also, more same-day operation patients had timely PA administration compared with patients admitted before the operation (80.4 vs. 66.9 percent). The study was supported by the Agency for Healthcare Research and Quality (HS13852).

See "Timely administration of prophylactic antibiotics for major surgical procedures," by Mary T. Hawn, M.D., M.P.H, F.A.C.S., Stephen H. Gray, M.D., Catherine C. Vick, M.S., and others, in the December 2006 Journal of the American College of Surgeons 203, pp. 803-811.

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