title: Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project.
abstract: OBJECTIVE
  Surgical site infections (SSIs) are a major contributor to patient injury, mortality, and health care costs. Despite evidence of effectiveness of antimicrobials to prevent SSIs, previous studies have demonstrated inappropriate timing, selection, and excess duration of administration of antimicrobial prophylaxis. We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery.
  
  
  METHODS
  National retrospective cohort study with medical record review.
  
  
  METHODS
  Two thousand nine hundred sixty-five acute-care US hospitals.
  
  
  METHODS
  A systematic random sample of 34,133 Medicare inpatients undergoing coronary artery bypass grafting; other open-chest cardiac surgery (excluding transplantation); vascular surgery, including aneurysm repair, thromboendarterectomy, and vein bypass operations; general abdominal colorectal surgery; hip and knee total joint arthroplasty (excluding revision surgery); and abdominal and vaginal hysterectomy from January 1 through November 30, 2001.
  
  
  METHODS
  The proportion of patients who had parenteral antimicrobial prophylaxis initiated within 1 hour before the surgical incision; the proportion of patients who were given a prophylactic antimicrobial agent that was consistent with currently published guidelines; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery.
  
  
  RESULTS
  An antimicrobial dose was administered to 55.7% (95% confidence interval [CI], 54.8%-56.6%) of patients within 1 hour before incision. Antimicrobial agents consistent with published guidelines were administered to 92.6% (95% CI, 92.3%-92.8%) of the patients. Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7% (95% CI, 40.2%-41.2%) of patients.
  
  
  CONCLUSIONS
  Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery.
authors.affiliation: Oklahoma Foundation for Medical Quality, Inc, Oklahoma City, OK 73134-2627, USA. dbratzler@okqio.sdps.org
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Peter M
authors.initials: PM
authors.lastname: Houck
authors.forename: Chesley
authors.initials: C
authors.lastname: Richards
authors.forename: Lynn
authors.initials: L
authors.lastname: Steele
authors.forename: E Patchen
authors.initials: EP
authors.lastname: Dellinger
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.forename: Claudia
authors.initials: C
authors.lastname: Wright
authors.forename: Allen
authors.initials: A
authors.lastname: Ma
authors.forename: Karina
authors.initials: K
authors.lastname: Carr
authors.forename: Lisa
authors.initials: L
authors.lastname: Red
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D019643:Arthroplasty, Replacement; D006348:Cardiac Surgical Procedures; D004359:Drug Therapy, Combination; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D006278:Medicare; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors; D014481:United States; D014656:Vascular Surgical Procedures
chemical_list: D000900:Anti-Bacterial Agents