Antibiotic Prophylaxis in Surgical Sterilization: Following the Recommendations [29G

Abstract

INTRODUCTION: Surgical site infections are the most common surgical complication. Antibiotic administration perioperatively has been shown to reduce associated morbidity, however, indiscriminate use has been associated with adverse outcomes. Selective antibiotic prophylaxis guidelines have been published by the American College of Obstetricians and Gynecologists (ACOG) for gynecologic procedures. Little is known regarding adherence to these recommendations. The primary objective was to determine adherence to ACOG recommendations for antibiotic prophylaxis in surgical sterilization. The secondary objective was to evaluate the patterns and predictors of appropriate antibiotic prophylaxis. METHODS: A retrospective chart review of preoperative antibiotics for laparoscopic and hysteroscopic sterilization procedures was performed at a single institution, Banner University Medical Center - Phoenix (BUMCP), from 01/01/2014 to 12/31/2014. Descriptive data were analyzed using chi-squared for categorical variables and Student t-test for continuous variables. P-values <.05 were considered significant. RESULTS: Of 165 women who met inclusion criteria, 50.9% received antibiotic prophylaxis outside of ACOG guidelines. Patient age, race and insurance status were not predictive of inappropriate prophylaxis. Women who underwent hysteroscopic sterilization were less likely to receive inappropriate prophylaxis compared to laparoscopic sterilization (18.6% vs 68.9%, P<.001). Antibiotic administration was less likely in cases assisted by lower-level residents compared to cases assisted by upper-level residents (46.4% vs 69.4%, P=.02). The number of years of attending experience was not predictive of adherence. CONCLUSION: There is widespread misuse of perioperative antibiotics for surgical sterilizations. Increased education and quality improvement is needed within BUMCP (our institution) to align practice patterns with evidence based recommendations.