A pre-operative allergy clinic: The first thousand patients

Abstract

Rationale We developed a clinical pathway to optimize the use of antibiotics in pre-operative patients with self-reported penicillin (PCN) allergy. Methods In 2001, our institution developed a preoperative evaluation (POE) clinic for elective surgical patients. In June 2002, on-site, same-day allergy consultation and penicillin skin testing was available for pre-operative patients with self-reported PCN allergy. We reviewed the antibiotic recommendations and estimated charges of patients seen from June 1, 2002-September 16, 2003. Results 11,819 patients were seen at the POE clinic and 1204 were evaluated for PCN allergy. Of the 1204 patients, 1139 underwent skin testing for PCN allergy. 62 (5%) had one or more positive skin tests to PCN. Only 188 were recommended to use vancomycin or non-beta lactam antibiotic. The top three surgical specialties represented in the POE clinic were orthopedic (28.4%), urology (22%) and neurosurgery (15%). Of the first 460 patients evaluated for PCN allergy, 24 patients received prolonged (6 weeks) antimicrobial therapy, 16 (64%) received cefazolin and 8 (32%) received vancomycin. For these 24 patients, we estimate a savings of $7541 per patient for cefazolin therapy compared with vancomycin therapy ($8311 vs $15852), and a cost of $360 for allergy evaluation and testing. Thus, we estimate a net savings of $114,896 for these 24 patients. Conclusions Pre-operative allergy evaluation for patients with self-reported PCN allergy can result in significant reduction of vancomycin use. Preoperative allergy evaluation may also reduce expenditures for patients requiring prolonged antimicrobial therapy.