Preoperative antibiotics and mortality in the elderly.
OBJECTIVE
It is generally thought that the use of preoperative antibiotics reduces the risk of postoperative infection, yet few studies have described the association between preoperative antibiotics and the risk of dying. The objective of this study was to determine whether preoperative antibiotics are associated with a reduced risk of death.


METHODS
We performed a multivariate matched, population-based, case-control study of death following surgery on 1362 Pennsylvania Medicare patients between 65 and 85 years of age undergoing general and orthopedic surgery. Cases (681 deaths within 60 days from hospital admission) were randomly selected throughout Pennsylvania using claims from 1995 and 1996. Models were developed to scan Medicare claims, looking for controls who did not die and who were the closest matches to the previously selected cases based on preoperative characteristics. Cases and their controls were identified, and charts were abstracted to define antibiotic use and obtain baseline severity adjustment data.


RESULTS
For general surgery, the odds of dying within 60 days were less than half in those treated with preoperative antibiotics within 2 hours of incision as compared with those without such treatment: (odds ratio = 0.44; 95% confidence interval, 0.32-0.60), P < 0.0001). For orthopedic surgery, no significant mortality reduction was observed (OR = 0.85; 95% confidence interval, 0.54-1.32; P < 0.464).


CONCLUSIONS
Preoperative antibiotics are associated with a substantially lower 60-day mortality rate in elderly patients undergoing general surgery. In patients who appear to be comparable, the risk of death was half as large among those who received preoperative antibiotics.
Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA. silberj@wharton.upenn.deu
Jeffrey H
JH
Silber
Paul R
PR
Rosenbaum
Martha E
ME
Trudeau
Wei
W
Chen
Xuemei
X
Zhang
Scott A
SA
Lorch
Rachel Rapaport
RR
Kelz
Rachel E
RE
Mosher
Orit
O
Even-Shoshan
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019072:Antibiotic Prophylaxis; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000379:methods / Q000401:mortality*; D013530:Surgical Wound Infection / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate