title: The economics and timing of preoperative antibiotics for orthopaedic procedures.
abstract: BACKGROUND
  The efficacy of antibiotics in preventing surgical site infections (SSIs) depends on the timing of administration relative to the start of surgery. However, currently, both the timing of and recommendations for administration vary substantially.
  
  
  OBJECTIVE
  To determine how the economic value from the hospital perspective of preoperative antibiotics varies with the timing of administration for orthopaedic procedures.
  
  
  METHODS
  Computational decision and operational models were developed from the hospital perspective. Baseline analyses looked at current timing of administration, while additional analyses varied the timing of administration, compliance with recommended guidelines, and the goal time-interval.
  
  
  RESULTS
  Beginning antibiotic administration within 0-30 min prior to surgery resulted in the lowest costs and SSIs. Operationally, linking to a pre-surgical activity, administering antibiotics prior to incision but after anaesthesia-ready time was optimal, as 92.1% of the time, antibiotics were administered in the optimal time-interval (0-30 min prior to incision). Improving administration compliance from 80% to 90% for this pre-surgical activity results in cost savings of $447 per year for a hospital performing 100 orthopaedic operations a year.
  
  
  CONCLUSIONS
  This study quantifies the potential cost-savings when antibiotic administration timing is improved, which in turn can guide the amount hospitals should invest to address this issue.
authors.forename: B A
authors.initials: BA
authors.lastname: Norman
authors.forename: S M
authors.initials: SM
authors.lastname: Bartsch
authors.forename: A P
authors.initials: AP
authors.lastname: Duggan
authors.forename: M B
authors.initials: MB
authors.lastname: Rodrigues
authors.forename: D R
authors.initials: DR
authors.lastname: Stuckey
authors.forename: A F
authors.initials: AF
authors.lastname: Chen
authors.forename: B Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics*; D019072:Antibiotic Prophylaxis / Q000191:economics* / Q000379:methods*; D003365:Costs and Cost Analysis; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents