Background: Perioperative antibiotics are not recommended for surgical procedures with class I (clean) wounds, unless infection would be catastrophic. We sought to examine the rate of antibiotic use for low risk, clean procedures, and determine if perioperative antibiotic use was influenced by location where surgery was performed (ambulatory surgical center [ASC] vs. hospital-based [HB]) or surgical specialty.
Methods: We conducted a retrospective analysis of perioperative antibiotic use for two ambulatory procedures: lesion excision and hernia repair surgeries. All procedures were performed in a pediatric healthcare network that includes a large, HB operating room complex and 3 ASCs. We included procedures performed in both HB and ASC locations covered by the same pediatric surgeons between February 2011 and June 2014 and excluded cases with multiple procedures. We conducted a cohort study to compare antibiotic use by location (ASC vs. HB) and matched procedures on surgeon, procedure type (type of excision or hernia), year, and age less than 2 years (hernias only). To compare antibiotic use by surgical specialty, we fit a fixed effects logistic model. Analyses were standardized for location, type of excision or hernia, year, and age (hernias only), and adjusted for clustering by surgeon. Excisions and hernias were analyzed separately.
Results: Overall, 3% (92/2850) of hernia repairs and 28% (824/2987) of excisions received perioperative antibiotics. Matched pairs were identified for 1281 hernia repairs and 1427 excisions. For hernia repairs, the probability of receiving antibiotics was greater for procedures performed at HB as compared to an ASC (0.054 vs. 0.012; risk ratio 4.3; p<0.001). Similarly, for excisions, the probability of receiving antibiotics was greater for procedures performed at HB as compared to an ASC (0.394 vs. 0.183; risk ratio 2.2; p<0.001). Use of antibiotics varied greatly by surgical specialty for both types of procedures (Figure 1).
Conclusion: Perioperative antibiotic use for clean, ambulatory surgical procedures seemed to be driven by surgeon- or location-specific (and not patient-specific) factors. These common procedures could be important targets for antimicrobial stewardship.
S. Coffin, None
J. S. Gerber, None