Association between hospital characteristics and rate of prophylactic antibiotic use over 1 day for clean surgery: A nationwide cohort study.

Abstract

The timing of prophylactic antibiotic use has become a hospital's surgical quality indicator. This study aims to assess the association of hospital characteristics with rate of prophylactic antibiotic use over 1 day for clean surgery. The retrospective cohort study was conducted using open government data, and hospitals must legally disclose to Taiwan's National Health Insurance Administration (NHIA). We identified 278 hospitals that reported 9491 records of prophylactic antibiotic use over 1 day for clean surgery from the 2009 first quarter to the 2019 fourth quarter. Regression models with generalized estimating equations were estimated. Overall, the median rate of prophylactic antibiotic use over 1 day for clean surgery in hospitals was 11.1% (interquartile range: 1.9% to 30%). Multivariable analyses showed that regional (coefficient [B] = 9.45, 95% confidence interval [CI]: 6.02-12.87, P < .001) and local hospitals (B = 15.04, 95% CI: 9.61-20.47, P < .001) had higher rates of prophylactic antibiotic use more than 1 day for clean surgery than medical centers. Moreover, public (B = 4.94, 95% CI: 0.61-9.28, P = .025) and medical care corporation hospitals (B = 8.17, 95% CI: 0.85-15.49, P = .029) experienced significantly greater proportions of antibiotic use over 1 day for clean surgery than medical care foundation hospitals after adjustments. This study revealed that low-level, public, and medical care corporation hospitals had higher rates of prophylactic antibiotic use over 1 day for clean surgery. These findings may represent a quality improvement opportunity for postoperative antibiotic use.