Abstract
BackgroundObesity is a risk factor for surgical site infections (SSI). Based on retrospective comparisons and pharmacology, many orthopedic centers have adopted weight- or body mass index (BMI)-related antibiotic prophylaxis. MethodsDouble-dose prophylaxis was introduced in March 2017 for patients weighting >80 kg. The period April 2014 to March 2017 (‘before’) was compared to the period March 2017 to June 2019 (‘after’) regarding the impact on deep SSIs. ResultsA total of 9318 surgeries ‘before’ were compared to 7455 interventions ‘after’ the introduction of double-dose prophylaxis. Baseline demographic characteristics (age, sex, BMI, American Society of Anesthesiologists score, and duration of surgery) were similar. In the period ‘after’, 3088 cases (3088/16 773; 18%) received double-dose prophylaxis. Overall, 82 deep SSIs were observed (0.5%). The pathogens were resistant to the standard cefuroxime prophylaxis in 30 cases (30/82; 37%). Excluding these prophylaxis-resistant cases and all of the five hematogenous SSIs, the remaining 47 SSIs (57%) could have been prevented by the preceding prophylaxis. Double-dosing of parenteral cefuroxime from 1.5 g to 3.0 g in obese patients did not reduce deep SSIs (hazard ratio 0.7, 95% confidence interval 0.3–1.6). In the direct group comparison among obese patients >80 kg, the double-dose prophylaxis equally failed to alter the SSI risk (3088/16 726 non-infections vs 8/47 SSI despite double-dose prophylaxis; Chi-square test, P = 0.78). ConclusionsIn this single-center before-and-after study with almost 17 000 orthopedic surgeries in adult patients, systemic doubling of the perioperative antibiotic prophylaxis in obese patients clinically failed to reduce the overall deep SSI risk.
Highlights
The incidence of deep surgical site infections (SSI) in adult orthopedic surgery varies between 0.1% and 3% (Uçkay et al, 2013)
With an electronic database of almost 17 000 surgeries and many obese patients, the impact of the double-dose prophylaxis on deep SSIs in obese patients was reevaluated in this study
The standard dose of 1.5 g cefuroxime intravenously was doubled to 3.0 g for patients weighing !80 kg and the dose was maintained elevated at 3 g for all consecutive doses
Summary
The incidence of deep surgical site infections (SSI) in adult orthopedic surgery varies between 0.1% and 3% (Uçkay et al, 2013). In addition to pharmacological considerations against the use of systemic weight-adapted prophylactic β-lactam antibiotics (Blum et al, 2019), a reduced SSI risk was not observed clinically after the doubling of the cefuroxime prophylaxis in obese patients at our institution 3 years ago. Double-dosing of parenteral cefuroxime from 1.5 g to 3.0 g in obese patients did not reduce deep SSIs (hazard ratio 0.7, 95% confidence interval 0.3–1.6). Conclusions: In this single-center before-and-after study with almost 17 000 orthopedic surgeries in adult patients, systemic doubling of the perioperative antibiotic prophylaxis in obese patients clinically failed to reduce the overall deep SSI risk.
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