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 surger...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-03-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13756-019-0503-9 |
| _version_ | 1818296553158213632 |
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| author | Westyn Branch-Elliman Steven D. Pizer Elise A. Dasinger Howard S. Gold Hassen Abdulkerim Amy K. Rosen Martin P. Charns Mary T. Hawn Kamal M. F. Itani Hillary J. Mull |
| author_facet | Westyn Branch-Elliman Steven D. Pizer Elise A. Dasinger Howard S. Gold Hassen Abdulkerim Amy K. Rosen Martin P. Charns Mary T. Hawn Kamal M. F. Itani Hillary J. Mull |
| author_sort | Westyn Branch-Elliman |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T04:05:22Z |
| format | Article |
| id | doaj.art-794994d5a2ab49419fd636583f13c585 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-13T04:05:22Z |
| publishDate | 2019-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-794994d5a2ab49419fd636583f13c5852022-12-22T00:00:13ZengBMCAntimicrobial Resistance and Infection Control2047-29942019-03-01811910.1186/s13756-019-0503-9Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort studyWestyn Branch-Elliman0Steven D. Pizer1Elise A. Dasinger2Howard S. Gold3Hassen Abdulkerim4Amy K. Rosen5Martin P. Charns6Mary T. Hawn7Kamal M. F. Itani8Hillary J. Mull9Department of Medicine, Section of Infectious Diseases, VA Boston Healthcare SystemPartnered Evidence-based Policy Resource Center (PEPReC), Department of Veterans AffairsVA Quality Scholars Program, Birmingham VA Medical CenterHarvard Medical SchoolCenter for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare SystemCenter for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare SystemCenter for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare SystemPalo Alto VA Medical CenterHarvard Medical SchoolCenter for Healthcare Organization and Implementation Research (CHOIR), VA Boston, Healthcare SystemAbstract 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.http://link.springer.com/article/10.1186/s13756-019-0503-9Ambulatory surgeryAntimicrobial stewardshipQuality improvementProphylaxisSurgical quality |
| spellingShingle | Westyn Branch-Elliman Steven D. Pizer Elise A. Dasinger Howard S. Gold Hassen Abdulkerim Amy K. Rosen Martin P. Charns Mary T. Hawn Kamal M. F. Itani Hillary J. Mull Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study Antimicrobial Resistance and Infection Control Ambulatory surgery Antimicrobial stewardship Quality improvement Prophylaxis Surgical quality |
| title | Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study |
| title_full | Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study |
| title_fullStr | Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study |
| title_full_unstemmed | Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study |
| title_short | Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study |
| title_sort | facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns a multi center retrospective cohort study |
| topic | Ambulatory surgery Antimicrobial stewardship Quality improvement Prophylaxis Surgical quality |
| url | http://link.springer.com/article/10.1186/s13756-019-0503-9 |
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