title: Factors associated with adherence to prophylactic antibiotic therapy for elective general surgeries in Japan.
abstract: OBJECTIVE
  To identify the factors associated with inappropriate antibiotic use during elective general surgeries.
  
  
  METHODS
  Cross-sectional analysis of administrative dataset.
  
  
  METHODS
  Sixty two acute-care hospitals in Japan.
  
  
  METHODS
  Two thousand and three hundred and seventy-three patients who had undergone inguinal hernia repair, appendectomy or laparoscopic cholecystectomy in 2004 and 2005.
  
  
  METHODS
  The appropriateness of antibiotic prophylaxis was evaluated in terms of the drug-selection and treatment-duration guidelines used in Japan, and the factors associated with guideline adherence were examined by multivariate logistic regression analysis.
  
  
  RESULTS
  The adherence rates for drug selection and treatment duration were 53-84 and 38-68% depending on surgical procedures, respectively. Patient age, sex and risk factors for surgical-site infections were not associated with inappropriate use of antibiotics after adjustment of other factors. The large size of the hospitals was significantly associated with inappropriate antibiotic usage. In hospitals with high surgical volume, the treatment duration was appropriate while antibiotic selection was relatively consistent but not adherent to the guidelines, implicating the presence of local practice routines.
  
  
  CONCLUSIONS
  Our results suggest that education and other methods should be used to encourage adherence to clinical guidelines on surgical antibiotic use, especially on duration of treatment. Increasing surgical volume may facilitate the standardization of clinical practice and improve the quality of health care.
authors.affiliation: Health Care Informatics Section, Department of Health Policy, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1138519, Japan.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Imai-Kamata
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000379:methods* / Q000592:standards; D001062:Appendectomy / Q000592:standards / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000592:standards / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006552:Hernia, Inguinal / Q000601:surgery; D006742:Hospital Bed Capacity; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing; D007564:Japan; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic