Abstract
BackgroundSurgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a clean surgery. The prevalence of SSIs can be minimised with the appropriate use of antibiotic prophylaxis as outlined in the Australian Therapeutic Guidelines (eTG). The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital following an update of the guidelines in 2014 and examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay.MethodA retrospective cross-sectional study which reviewed medical records from a random sample of 250 patients selected from 973 patients who underwent breast surgical procedures between February 2015 and March 2017.ResultsOverall adherence to current eTG occurred in 49.2% (123/250) of operations. Pre-operative and post-operative antibiotics were prescribed in 98.4% (246/250) and 11.2% (28/250) operations respectively. Adherence rates to three specific elements of the eTG (drug prescribed, drug dosage and timing of administration) were 91.6% (229/250), 53.6% (134/250) and 86.4% (216/250) respectively. For the 14.4% (36/250) patients with relevant drug allergies, there was zero adherence to the eTG. Overall recorded SSI prevalence was low at 5.2% (13/250). The mean length of stay in patients (2.3 ± 1.7 days) was not influenced by level of eTG adherence (p = 0.131) or SSIs (p = 0.306).ConclusionThese data demonstrate a significant improvement in overall adherence to the eTG from 13.3% to 49.2% (p = < 0.001). The level of detected SSIs in this study was low. Further improvement is necessary with respect to prescribing appropriate antibiotic dosages and for those with allergies.
Highlights
Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a ‘clean surgery’ (Cabaluna et al, 2013; Craft, Damjanovic & Colwell, 2012)
The prevalence of SSIs can be minimized with the appropriate use of pre-operative antibiotic prophylaxis (Ariyan et al, 2015; Jones, Bunn & Bell-Syer, 2014)
A total of 973 patients who underwent a breast surgery procedure between February 2015 and March 2017 at Sir Charles Gairdner Hospital (SCGH) were identified by the Pharmacy Department at SCGH using Medicare breast surgery codes by means of an electronic database
Summary
Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a ‘clean surgery’ (Cabaluna et al, 2013; Craft, Damjanovic & Colwell, 2012). The prevalence of SSIs can be minimized with the appropriate use of pre-operative antibiotic prophylaxis (Ariyan et al, 2015; Jones, Bunn & Bell-Syer, 2014) This has been demonstrated in patients undergoing breast surgery (Jaber et al, 2017). A recent study by Jaber et al (2017) in 2014 evaluated the appropriateness of surgical antibiotic prophylaxis for breast surgery procedures and found a statistically significant relationship between pre-operative prophylactic antibiotic use and successful SSI prevention. The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital following an update of the guidelines in 2014 and examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay. Further improvement is necessary with respect to prescribing appropriate antibiotic dosages and for those with allergies
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