Quality-initiated prophylactic antibiotic use in laparoscopic-assisted vaginal hysterectomy.
BACKGROUND
An evidence-based initiation of quality improvement activity for reducing the usage of prophylactic antibiotic in laparoscopic-assisted vaginal hysterectomy (LAVH) in a tertiary hospital.


OBJECTIVE
The authors investigated whether single or multiple doses of cefazoline were more cost-effective in preventing postoperative infection associated with LAVH.


METHODS
The study groups comprised of 310 patients who had undergone LAVH continuously in a medical centre. Patients were divided into two groups on the basis of whether they received a single dose or multiple doses (range: two to four doses) of cefazoline during the perioperative period. Postoperative infections such as pelvic cellulitis or abscess, vaginal cuff abscess, wound infection and urinary tract infection that occurred either during hospitalisation or within one month after discharge were observed and recorded. Incremental cost-effectiveness ratio (ICER) was calculated using the mean direct drug cost and the prophylactic effect of infection in both groups.


RESULTS
The prophylactic effect of infection was similar in the single-dose group and the multiple-dose group (94.6% vs 93.9%, P = 0.986). The ICER was significantly lower in the single-dose group (153.3 vs 460.4, P < 0.001).


CONCLUSIONS
The result revealed that a single dose of cefazoline is more cost-effective than multiple doses in the prevention of infection associated with LAVH. It fulfils the goal of cost minimisation and quality of care in today's environment of medical cost containment.
Chang
Wei-Chun
WC
Department of Obstetrics and Gynecology, China Medical University and Hospital, Taichung, Taiwan.
Lee
Meng-Chih
MC
Yeh
Lian-Shung
LS
Hung
Yao-Ching
YC
Lin
Cheng-Chieh
CC
Lin
Long-Yau
LY
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D002437:Cefazolin / Q000008:administration & dosage* / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods; D010535:Laparoscopy; D007902:Length of Stay; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D002437:Cefazolin