title: Use of guideline-based antibiotic prophylaxis in women undergoing gynecologic surgery.
abstract: OBJECTIVE
  To examine guideline-based use of prophylactic antibiotics in patients who underwent gynecologic surgery.
  
  
  METHODS
  We identified women who underwent gynecologic surgery between 2003 and 2010. Procedures were stratified as antibiotic-appropriate (abdominal, vaginal, or laparoscopically assisted vaginal hysterectomy) or antibiotic-inappropriate (oophorectomy, cystectomy, tubal ligation, dilation and curettage, myomectomy, and tubal ligation). Antibiotic use was examined using hierarchical regression models.
  
  
  RESULTS
  Among 545,332 women who underwent procedures for which antibiotics were recommended, 87.1% received appropriate antibiotic prophylaxis, 2.3% received nonguideline-recommended antibiotics, and 10.6% received no prophylaxis. Use of antibiotics increased from 88.0% in 2003 to 90.7% in 2010 (P<.001). Among 491,071, who underwent operations for which antibiotics were not recommended, antibiotics were administered to 197,226 (40.2%) women. Use of nonguideline-based antibiotics also increased over time from 33.4% in 2003 to 43.7% in 2010 (P<.001). Year of diagnosis, surgeon and hospital procedural volume, and area of residence were the strongest predictors of guideline-based and nonguideline-based antibiotic use.
  
  
  CONCLUSIONS
  Although use of antibiotics is high for women who should receive antibiotics, antibiotics are increasingly being administered to women for whom the drugs are of unproven benefit.
  
  
  METHODS
  : III.
authors.affiliation: Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, and the Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Khalid
authors.initials: K
authors.lastname: Hassan
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Yu-Shiang
authors.initials: YS
authors.lastname: Lu
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D019072:Antibiotic Prophylaxis / Q000592:standards*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards*; D006801:Humans; D013530:Surgical Wound Infection / Q000517:prevention & control*