Abstract
BackgroundThe optimal timing of preoperative surgical antimicrobial prophylaxis (SAP) remains uncertain. This study aimed to evaluate the impact of changing the timing of SAP on the incidence of surgical site infection (SSI) in laparoscopic surgery.MethodsWe performed a before-after study from August 2014 through June 2017 to assess the impact of changes in the timing of SAP on the incidence of SSI at a 790-bed tertiary care center in Japan. The intervention was the administration of SAP immediately after the study patients entered the operating room for laparoscopic surgery.ResultsIn total, 1397 patients who met the inclusion criteria were analyzed. After the intervention, the median time between the time of SAP completion and the time of surgical incision changed from 8 min to 26 min (p < 0.001), and the number of cases without SAP completion prior to surgical incision decreased (16.8% vs. 1.8%; p < 0.001). However, changes in the overall incidence of SSI did not significantly differ between the pre-intervention and the intervention groups (13.8% vs. 13.2%; p = 0.80).ConclusionsAlthough the timing of preoperative SAP improved, the intervention did not have a significant impact on reducing the incidence of SSI in the current study. Besides preoperative SAP, multidisciplinary approaches should be incorporated into projects aimed at comprehensively improving surgical quality to reduce SSI.
Highlights
Surgical site infection (SSI) is one of the most common healthcare-associated infections in the acute care setting [1]
The median interval between the time of completion of preoperative surgical antimicrobial prophylaxis (SAP) and the time of surgical incision changed from 8 min to 26 min (p < 0.001), and the number of cases without a complete preoperative SAP prior to surgical incision decreased (16.8% vs. 1.8%; p < 0.001)
A number of studies have examined the optimal timing of preoperative SAP, with some studies showing that administration within 30 min prior to incision decreased the risk of postoperative infection [9, 10]
Summary
Surgical site infection (SSI) is one of the most common healthcare-associated infections in the acute care setting [1]. Surgical antimicrobial prophylaxis (SAP) is one of the most important modifiable factors for reducing SSI incidence. Guidelines for preventing SSI were published by the World Health Organization (WHO) in 2016 and by the Centers for Disease Control and Prevention (CDC) in 2017 [1, 4]. These guidelines recommend preoperative SAP within one hour of surgical incision, the optimal timing of SAP during this period (e.g., 0–30 min versus 30–60 min before incision) remains unclear. This study aimed to evaluate the impact of changing the timing of SAP on the incidence of surgical site infection (SSI) in laparoscopic surgery
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