Compliance with guidelines on antibiotic prophylaxis in total hip replacement surgery: results of a retrospective study of 416 patients in a teaching hospital.
OBJECTIVE
To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines.


METHODS
Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis.


METHODS
Orthopedic surgery wards in a 2,200-bed French teaching hospital.


METHODS
A random sample of 416 patients undergoing THR from January 1999 to December 2000.


RESULTS
Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95 1.02-2.38).


CONCLUSIONS
The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.
Bedouch
Pierrick
P
Unité d'Evaluation Médicale, Centre Hospitalier Universitaire de Grenoble, France.
Labarère
José
J
Chirpaz
Emmanuel
E
Allenet
Benoit
B
Lepape
Alain
A
Fourny
Magali
M
Pavese
Patricia
P
Girardet
Pierre
P
Merloz
Philippe
P
Saragaglia
Dominique
D
Calop
Jean
J
Francois
Patrice
P
D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip; D001424:Bacterial Infections / Q000453:epidemiology; D003187:Compliance; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies