Clinical and economic outcomes of pharmacist-managed antimicrobial prophylaxis in surgical patients

Abstract

The associations between pharmacist-managed antimicrobial prophylaxis in Medicare patients who had surgical codes indicative of the need for antimicrobial prophylaxis and the major health care outcomes of death rate, length of stay, Medicare charges, drug charges, laboratory charges, and complications were explored. Pharmacist management of antimicrobial prophylaxis was evaluated in 242,704 Medicare patients from 860 [corrected] hospitals. Patients who developed a surgical-site infection (SSI) had a 331.58% increased risk of death compared with patients who did not develop an SSI (chi2 = 743.471; df = 1; p < 0.0001; odds ratio [OR], 3.62; 95% confidence interval [CI], 3.28-3.99). Patients who developed an SSI also had a 167.16% increase in length of stay, 136.49% increase in total Medicare charges, 245.96% increase in drug charges, and 187.14% increase in laboratory charges. In hospitals without pharmacist-managed antimicrobial prophylaxis, death rates were 52.06% higher (105 excess deaths; p < 0.0001; OR, 1.54; 95% CI, 1.46-1.63), length of stay was 10.21% higher (167,941 excess patient days, p < 0.0001), mean +/- S.D. total Medicare charges were 3.10% higher ($980 +/- $1,109 more per patient) ($182,113,400 excess total Medicare charges, p < 0.0001), mean +/- S.D. drug charges were 7.24% higher ($292 +/- $492 more per patient) ($54,262,360 excess drug charges, p = 0.005), mean +/- S.D. laboratory charges were 2.72% higher ($74 +/- $151 more per patient) ($13,751,420 excess laboratory charges, p = 0.0056), and SSIs were 34.30% higher (chi2 = 95.48; df = 1; p < 0.0001; OR, 1.52; 95% CI, 1.40-1.66). The provision of pharmacist-managed antimicrobial prophylaxis was associated with significant improvement in clinical and economic outcomes for Medicare patients with a surgical code indicative of the need for antimicrobial prophylaxis.