Rate Of Antibiotic Administration Research Articles

Antibiotics for 3rd and 4th Degree Vaginal Lacerations, Uterine Tamponade, and Manual Placental Extraction.

Trends in use of antibiotics during delivery hospitalizations complicated by (1) 3rd/4th degree vaginal lacerations, (2) manual placenta extraction, and (3) uterine tamponade are not well characterized. The objective of this study was to analyze trends in antibiotic use during vaginal delivery hospitalizations complicated by these three clinical scenarios. An administrative inpatient database was used to perform a serial cross-sectional analysis of antibiotic administration during delivery hospitalizations in the United States from January 2006 to March 2015. The primary outcome was receipt of antibiotics during vaginal delivery hospitalizations complicated by (1) 3rd and 4th degree vaginal lacerations, (2) manual placenta extraction, and (3) uterine tamponade. Patients with other indications for antibiotics were excluded. The Cochran-Armitage test was used to assess trends. Adjusted log linear regression analyses including demographic, hospital, and obstetric factors were performed to analyze factors associated with antibiotic receipt for each of these three clinical scenarios in both primary and sensitivity analyses. From 2006 to 2015 the rate of antibiotic administration during delivery hospitalizations decreased from 43.1% in 2006 to 25.5% for 3rd and 4th degree lacerations and from 59.6% to 49.2% for manual extraction (p < 0.01). Administration of antibiotics in the setting of uterine tamponade decreased from 48.6% in 2006 to 27.6% in 2009 before rising to 62.5% in the first quarter of 2015. In adjusted analyses, comparing the first quarter of 2015 to 2006 adjusted risk ratios for antibiotic administration were 0.61 (95% confidence interval [CI] 0.56-0.66) for 3rd and 4th degree vaginal lacerations, 0.76 (95% CI 0.53-1.09) for manual placental extraction, and 0.83 (95% CI 0.76-0.92) for uterine tamponade. Antibiotics are not used consistently during vaginal deliveries complicated by 3rd/4th degree lacerations, manual placenta extraction, and uterine tamponade. These findings support that a significant opportunity exists for comparative effectiveness research to assist in characterizing best practices.

148 Rate of Antibiotics Prescribed for Patients With Acute Diarrheal Illness and a Positive Stool Test in Immunosuppressed Versus Non-Immunosuppressed Patients

INTRODUCTION: Historically, the diagnostic yield of stool culture in patients with acute diarrheal illness (ADI) is very low. As such, the decision to administer antibiotics is usually guided by history of exposures, symptoms, and the degree of immune-competence. The advent of a gastrointestinal (GI) pathogen PCR panel offers a sensitive and rapid identification of various GI pathogens but its heuristic relevance in antibiotic stewardship for immunosuppressed patients is unknown. We aimed to compare the rate of antibiotics prescribed for ADI with positive GI pathogen PCR panel results in immunosuppressed and non-immunosuppressed patients. METHODS: Patients who presented to Montefiore Medical Center with an ADI with a positive GI pathogen PCR panel between April 2018 and November 2018 were identified. Data collected included patient demographics, toxic habits, and previous antibiotic and steroid use within 6 months prior to the ADI. Immunosuppressed patients were identified as having either HIV/AIDS, a history of organ transplant, active hematologic malignancy, primary immunodeficiency disease or current use of immunosuppressive medications. We excluded patients with C. difficile given its confounding effect on the rate of antibiotic administration. The primary outcome was whether antibiotics were prescribed for the ADI empirically as well as in response to a positive GI pathogen PCR panel result. RESULTS: Out of 472 patients, 102 patients (21.6% of the cohort) were identified as being immunosuppressed (Table 1). There was no significant difference in the rate of empiric antibiotic use between immunosuppressed and non-immunosuppressed patients with ADI (12.2% vs 10.8%, P = 0.181) (Table 2). There was also no significant difference in the rate of antibiotic use in response to a positive GI pathogen PCR panel result (49% vs 38.9%, P = 0.182). CONCLUSION: The ability to tailor treatment to a specific pathogen in patients with ADI does not appear to make a significant difference in the rate of antibiotic use when accounting for patients' immune-competence. As certain pathogens warranting treatment tend to be more common in immunosuppressed patients, the implications on clinical outcomes and cost effectiveness of the GI pathogen PCR panel requires further study.

Positive Impact of a Point-of-Care Molecular Influenza Test in the Emergency Department During the 2017-2018 Seasonal Influenza Epidemic.

During the 2017–2018 flu epidemic, the point-of-care Alere-i (n = 72) and reverse transcription polymerase chain reaction (n = 106) tests were compared. Patients in the point-of-care group were administered oseltamivir significantly more rapidly (9 hours vs 23 hours), they spent less time in the emergency department, and they had lower rates of antibiotic administration and hospitalization.

Current Use of Antibiotics among Vietnamese People in the First Level of Healthcare System in Nam Dinh Province

In Vietnam, the national public healthcare services and statistics reveal problems with antibiotic use in the community with misunderstandings leading to the irrational and inappropriate use of these drugs resulting in bacterial resistance together with its consequences. There have been studies in Vietnam revealing a major problem in prescribing in the acute sector, but most antibiotics are prescribed in the community and there had been no studies exploring the situation in the community. This study was therefore an evaluation of the knowledge, skills and prescribing practice of those primarily responsible for administering antibiotics in the community, and was the first of its kind in Vietnam. The study used method triangulation to evaluate antibiotic use in the study location, a district in one province in North Vietnam. The district was chosen as it was typical of other rural areas in North Vietnam. The findings revealed a very high rate of antibiotic administration (79.8%) of which more than half (54%) were incorrectly prescribed for non-infectious conditions. Also, misunderstandings, limited knowledge and perceptions regarding the use of antibiotics, with staff having had little post basic training and education. It is further recommended that similar studies will be conducted along this line to verify the findings of the study.

Prescription of Antibiotics for Adults with Acute Infectious Diarrhea in Korea: A Population-based Study.

BackgroundAcute infectious diarrhea (AID) is a commonly observed condition globally. Several studies recommend against the use of empiric antibiotic therapy for AID, except in some cases of travelers' diarrhea. However, many physicians prescribe antimicrobial agents for AID. We aimed to determine the rate of antibiotic use and the associated prescription patterns among adults with AID.Materials and MethodsThis population-based, retrospective epidemiological study was performed using Korean National Health Insurance claims data from 2016 to 2017. The study population comprised adults (age ≥18 years) who had visited clinics with AID-related complaints. Exclusion criteria were the presence of Crohn's disease, ulcerative colitis, irritable bowel syndrome, and other non-infectious forms of colitis. Patients who underwent surgery during admission were also excluded.ResultsThe study population comprised 1,613,057 adult patients with AID (767,606 [47.6%] men). Young patients (age 18 – 39 years) accounted for 870,239 (54.0%) of the study population. Overall, 752,536 (46.7%) cases received antibiotic prescriptions. The rate of antibiotic administration tended to be higher among elderly patients (age ≥65 years) than among younger patients (49.5% vs. 46.4%, P <0.001). The antibiotics most frequently prescribed in both monotherapy and combination regimens were fluoroquinolones (29.8%), rifaximin (26.8%), second-generation cephalosporins (9.2%), third-generation cephalosporins (7.3%), trimethoprim/sulfamethoxazole (5.5%), and β-lactam/β-lactamase inhibitors (5.3%). Patients who visited tertiary care hospitals had lower rates of antibiotic therapy (n = 14,131, 41.8%) than did those visiting private clinics (n = 532,951, 47.1%). In total, 56,275 (62.3%) admitted patients received antibiotic therapy, whereas outpatients had lower rates of antibiotic prescription (n = 694,204, 46.0%).ConclusionThis study revealed differences between the antibiotics used to treat AID in Korea and those recommended by the guidelines for AID treatment. Multifaceted efforts are necessary to strengthen physicians' adherence to published guidelines.

Risk Classification for Enteroviral Infection in Children With Meningitis and Negative Gram Stain.

Enterovirus is the most common cause of aseptic meningitis in children. This study aimed at identifying baseline variables associated with a positive cerebrospinal fluid (CSF) Enterovirus polymerase chain reaction (PCR) to aid clinicians in targeting patients who could be tested and treated as outpatients. We performed a retrospective review of children (2 months to 17 years old) admitted to the Children's Memorial Hermann Hospital in Houston, TX, between January 2005 and December 2010 with symptoms of meningitis, CSF white cell count of greater than 5 cells/mm, and a negative CSF Gram stain, who had a CSF Enterovirus PCR. One hundred thirty-seven children were reviewed; median age was 4.7 (0.1-17.1) years, and 79 (58%) were male. Fifty patients (37%) had positive CSF Enterovirus PCR. Only 13 (15%) of the Enterovirus PCR-negative patients had an identifiable etiology. All patients were hospitalized. The mean hospital stay for patients with Enterovirus was 2.9 days; 88% received empiric antibiotics. Rates of antibiotic administration were not different between PCR-positive and PCR-negative groups (P > 0.05). All patients with Enterovirus had a favorable clinical outcome.A predictive model was created using 3 baseline variables independently associated with a positive Enterovirus PCR (P < 0.05): May to November presentation, CSF protein of less than 100 mg/dL, and absence of focal neurologic signs. The model classified patients into 2 risk categories for a positive Enterovirus PCR (low risk, 0% [0/17 patients]; high risk, 42% [50/120 patients]; P < 0.001). Our predictive model can be used to identify children for whom Enterovirus PCR testing is warranted. Such testing could avoid unnecessary hospitalization and antibiotic administration.

The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock.

This study evaluates whether emergency department septic shock patients without a fever (reported or measured) receive less IV fluids, have decreased antibiotic administration, and suffer increased in-hospital mortality. This was a secondary analysis of a prospective, observational study of patients with shock. The study was conducted in an urban, academic emergency department. The original study enrolled consecutive adult (aged 18 yr or older) emergency department patients from November 11, 2012, to September 23, 2013, who met one of the following shock criteria: 1) systolic blood pressure less than 90 mm Hg after at least 1L IV fluids, 2) new vasopressor requirement, or 3) systolic blood pressure less than 90 mm Hg and IV fluids held for concern of fluid overload. The current study is limited to patients with septic shock. Patients were grouped as febrile if they had a subjective fever or a measured temperature >100.4°F documented in the emergency department; afebrile patients lacked both. Among 378 patients with septic shock, 207 of 378 (55%; 50-60%) were febrile by history or measurement. Afebrile patients had lower rates of antibiotic administration in the emergency department (81% vs 94%; p < 0.01), lower mean volumes of IV fluids (2,607 vs 3,013 mL; p < 0.01), and higher in-hospital mortality rates (33% vs 11%; p < 0.01). After adjusting for bicarbonate less than 20 mEq/L, lactate concentration, respiratory rate greater than or equal to 24 breaths/min, emergency department antibiotics, and emergency department IV fluids volume, being afebrile remained a significant predictor of in-hospital mortality (odds ratio, 4.3; 95% CI, 2.2-8.2; area under the curve = 0.83). In emergency department patients with septic shock, afebrile patients received lower rates of emergency department antibiotic administration, lower mean IV fluids volume, and suffered higher in-hospital mortality.

Impact of a Sepsis Guideline in Emergency Department on Outcome of Patients with Severe Sepsis

Objective A dedicated program with guideline to enhance sepsis care was launched in July 2014 in Emergency Department (ED) of two regional hospitals. The study aimed to evaluate the effectiveness of the interventional program for severe sepsis patients, in antibiotic delivery rate and survival outcome. Methods It is a before-and-after interventional study with data from July to December 2013 and August 2014 to January 2015. A dedicated program for severe sepsis patients was introduced in July 2014. The outcome measures were blood culture rate, antibiotic administration rate in ED and mortality. Kaplan-Meier analysis and log-rank test was used for comparison of the survival. Multivariate Cox proportional hazards model was constructed to predict time to mortality adjusted for covariates. Results 64 patients were included, 31 patients were in the pre-intervention group whereas 33 post-intervention. Both blood culture rate (29% vs 72.7%; p&lt;0.001) and antibiotics administration in ED (38.7% vs 72.7%, p=0.0011) were significantly increased. Survival outcome was significantly improved in patients receiving timely antibiotics in ED (log-rank test p=0.016). Antibiotics administered in ED had hazard ratio of 0.178 (95% CI 0.053 to 0.595; p=0.005) in the Cox Proportional hazard regression model with adjustment of covariates. Age (adjusted odds ratio 1.06, 95% CI 1.01 to 1.12, p=0.033) and initial hypotension (adjusted odds ratio 0.97, 95% CI 0.95 to 0.99, p=0.005) were significant predictors of mortality. Conclusion A dedicated guideline for severe sepsis management could improve blood culture rate, early antibiotics administration in the emergency department. Patients received early antibiotic had better outcome and survival.

Compliance of Perioperative Antibiotic Dosing and Surgical Site Infection Rate in Office-Based Elective Surgery.

Background:A best practice goal to reduce surgical site infection includes administration of antibiotics in the ideal preoperative window. This article evaluates an office surgical suite antibiotic administration rate and compares it with the timing of a local hospital treating a similar patient population. The hypothesis was that similar or better compliance and surgical site infection rates can be achieved in the office-based suite.Methods:A total of 277 office-based surgeries were analyzed for antibiotic administration time before incision and their corresponding surgical site infection rate.Results:Our facility administered timely prophylactic antibiotics in 96% of cases with a surgical site infection rate of 0.36%. This rate was significantly lower than a reported rate of 3.7%.Conclusion:Low infection rates with high antibiotic administration rate suggest that compliance with best possible practice protocols is possible in the outpatient setting.

The Effect of the Rapid Antigen Test for Influenza on Clinical Practice in the Emergency Department: A Comparison of Periods before and After the 2009 H1N1 Influenza Pandemic

Introduction. The rapid antigen test (RAT) plays an important role in the Emergency Room (ER). In this study, we investigated the effect of the RAT for influenza on clinical practice in an emergency department.Methods. A retrospective chart review was conducted considering two periods, namely before and after the 2009 influenza pandemic. The rate of antibiotic administration, the use of blood sample tests, the use of simple chest X-rays, the rate of antibiotic administration according to the result of the RAT, and the duration of ER stay in the case of influenza-like illnesses were investigated for the two study periods considered.Results. The use of the RAT increased from 23.9% to 39.8% in influenza-like pediatric patients (p<0.05) and from 4.9% to 67.6% in adult patients (p<0.001). After the 2009 influenza pandemic, the number of cases of antibiotic administration, blood sample test and simple chest X-ray decreased by 19.0%, 46.2%, and 27.4%, respectively, in pediatric patients with the use of RAT. Among RAT-positive patients, after the 2009 influenza pandemic, none of the pediatric patients and only 3 of the adult patients (17.6%) were administered antibiotics. The duration of ER stay was longer in patients who underwent RAT than in those who did not.Conclusion. The increased use of RAT for influenza has led to a decrease in antibiotic administration and a reduction in additional diagnostic tests in influenza-like illnesses. However, the use of RAT has not contributed to a decrease in the duration of ER stay.

Hospital and Surgeon Adherence to Pediatric Tonsillectomy Guidelines Regarding Perioperative Dexamethasone and Antibiotic Administration

Objectives: American Academy of Otolaryngology—Head and Neck Surgery 2011 guidelines for pediatric tonsillectomies recommend routine administration of perioperative dexamethasone and against routine antibiotic administration. The purpose of this study is to review adherence to these 2 guidelines. Methods: An observational cohort was reviewed of all children ages 1 to 18 years undergoing same-day-surgery adenotonsillectomy (T&amp;A) at a multi-hospital network from 2007 to 2012. A standardized electronic data system was used to determine whether dexamethasone and/or antibiotics were given in the hospital. The rate of dexamethasone and antibiotic administration was compared in the years 2007 to 2011 (preguidelines) with the year 2012 (postguidelines). Results: The study cohort included 16,310 children undergoing T&amp;A at 19 hospitals by 61 surgeons. A total of 91.3% of the patients from 2007 to 2011 (N = 13,557) received dexamethasone compared with 93.2% of the children in 2012 (N = 2,753). A total of 18.2% of the children from 2007 to 2011 received antibiotics compared with 14.7% in 2012 ( P &lt; .05). Dexame-thasone was given in the majority of cases before and after the guidelines were published. Seventeen of the 61 surgeons administered antibiotics in more than 50% of the cases in 2007 to 2011. Postguidelines in 2012, only 2 of these 17 surgeons adhered to the guidelines by not giving antibiotics in the majority of cases. Conclusions: The majority of hospitals and surgeons administered perioperative dexamethasone before and after the guidelines were published. While the rate of antibiotic administration statistically decreased in 2012 compared to 2007-2011, only 2 surgeons appeared to have changed their practice. With the purpose of the guideline to limit the risks and side effects of perioperative antibiotics, interventions are needed to improve guideline adherence.

A secondary analysis of the WHO Global Survey on Maternal and Perinatal Health for antibiotics used in vaginal deliveries

ObjectiveTo assess the rate of antibiotic administration following vaginal delivery and to determine whether maternal characteristics and healthcare system features affected antibiotic use during or immediately after delivery using data from the WHO Global Survey on Maternal and Perinatal Health in Latin America, Africa, and Asia. MethodsThe study included women who delivered vaginally without any obvious infection, diabetes, HIV, cardiorenal or respiratory disease, urinary tract infection, or rupture of membranes. The proportion of women receiving antibiotics within and across regions was determined and associated factors of prophylactic use were analyzed using generalized linear mixed models. ResultsOf the 171 676 women giving birth vaginally, 47.3% received antibiotics, with half of these women receiving antibiotics during and/or immediately after delivery for prophylaxis. Among 131 554 women given prophylactic or no antibiotics, 31.2% received prophylactic antibiotics but the rate varied among regions. Women with an operative vaginal delivery (compared with those who delivered spontaneously) and women with third- or fourth-degree laceration were more likely to receive prophylactic antibiotics. ConclusionAntibiotic use following vaginal delivery varies widely across geographic regions; however, approximately one-third of women undergoing vaginal delivery without documented indication for antibiotic administration appear to have received antibiotics.

Effect of Preoperative Magnetic Resonance Imaging Diagnosis of Osteomyelitis on the Surgical Management and Outcomes of Pressure Ulcers

Despite advances in imaging technology, it is unclear whether preoperative MRI diagnosis of osteomyelitis influences surgical management and improves surgical outcome. The purpose of this retrospective study was to determine whether preoperative diagnosis of osteomyelitis by pelvic MRI influenced the surgical management of pressure sores and flap outcomes. The characteristics, pre- and intraoperative management, and surgical outcomes of the most recent flap surgery in 2 groups were compared: 26 patients diagnosed with osteomyelitis by preoperative MRI and 21 patients diagnosed by culture growth from an intraoperative bone specimen postoperatively. Patients with osteomyelitis diagnosed by MRI had 10 ulcer recurrences at the same site (39%) versus 6 (29%) among patients with osteomyelitis diagnosed by bone culture (odds ratio = 2.4, P = 0.22). We found that patients with a diagnostic preoperative MRI did not differ significantly in rates of antibiotic administration, ostectomy, dehiscence, revision, or infection.

Point-of-Care Electronic Prompts

Incentives based on quality indicators such as the Surgical Care Improvement Project core measures (SCIP 1) encourage implementation of evidence-based guidelines consistently into clinical practice. Information systems with point-of-care electronic prompts (POCEPs) can facilitate adoption of processes and benchmark performance. We evaluated the effectiveness of POCEPs on rates of antibiotic administration within 60 minutes of surgical incision and effect on outcome in a prospective observational trial. SCIP 1 compliance and the corresponding outcome variable (surgical site infection [SSI]) were examined prospectively over 2 consecutive 6-month periods before (A) and after (B) POCEPs implementation at a regional health system. Secondary analysis extended the observation to two 12-month periods (A' and B'). A 2-year (C and D) sustainability phase followed. The 19,744 procedures included 9127 and 10,617 procedures before (A) and after (B) POCEPs implementation, respectively. POCEPs increased compliance with SCIP indicators in period B by 31% (95% CI, 30.0%-32.2%) from 62% to 92% (P < 0.001) and were associated with a sustainable, contemporaneous decrease in the incidence of SSI from 1.1% to 0.7% (P = 0.003; absolute risk reduction, 0.4%; 95% CI, 0.1%-0.7%). Secondary and sustainability analysis revealed that compliance rates remained >95% with mean SSI rates lower for all periods compared with pre-POCEPs SSI rates (0.8%, 0.7%, and 0.5% vs 1.1%; P < 0.001). POCEPs increased compliance with SCIP indicators by >30% and were associated with a 0.4% absolute risk reduction in the incidence of SSI. POCEPs may be useful to modulate provider behavior and demonstrate intraoperative quality and value.

Pay for Performance for Antibiotic Timing in Pneumonia: Caveat Emptor

Health care practitioners and hospital administrators have focused on a performance measure regarding antibiotic timing for patients with community-acquired pneumonia in anticipation of a pay-for-performance program through the Centers for Medicare & Medicaid Services (CMS) and private payers. Early antibiotic administration is associated with improved outcomes, even after adjusting for severity. Yet although some patients may benefit through the early administration of antibiotics, there is a risk to other patients who are treated concurrently. Some patients' care may be delayed because they may not receive the same priority as patients with suspected pneumonia. Other patients may receive inappropriate antibiotics for suspected pneumonia to shorten the time to administration. Attempts to address the performance measure are probably dependent on how well the emergency department functions and the level of crowding. Patients with a suspected pneumonia may be empirically covered with antibiotics before radiographic diagnosis, which should increase the rate of antibiotic administration for antibiotic-nonresponsive conditions and contribute to antibiotic resistance. The answer is to find measures of system throughput and/or work flow that are associated with improved patient care outcomes.

A comparison of fever management by pediatric-trained and non–subspecialty-trained emergency physicians

Study objectives: In 1993, the American Academy of Pediatrics and the American College of Emergency Medicine jointly published guidelines for the management of fever without a source in infants and young children. Despite widespread recognition in the literature, actual compliance with these guidelines has produced a far different picture and demonstrates that acceptance has been less than robust. Our null hypothesis is that no differences exist between general emergency physicians and pediatric emergency physicians in evaluating infants and young children with fever. Methods: The research protocol was approved by the Inova Fairfax institutional review board. The Inova Fairfax Hospital emergency department (ED) is a general ED with an annual pediatric census of 21,000. The emergency pediatric section consists of 10 subspecialty-trained emergency physicians. Consecutive medical records of febrile children younger than 36 months were retrospectively examined between December 1, 2003, and March 31, 2004. Evaluation and management of fever in the well-appearing child by physicians with advanced pediatric training and general emergency medicine training were compared with accepted published guidelines. Fever thresholds used were 38.0°C for children younger than 1 month, 38.2°C for children aged 31 to 90 days, and 38.5°C for children older than 3 months of age. General emergency physician and pediatric emergency physician practices were compared for diagnostic studiesials. Nominal data were analyzed using either χ² or Fisher's exact tests. Parametric continuous data were analyzed using a <i>t</i> test. Means and confidence intervals (CIs) were calculated. α Was set at 0.05 for all comparisons. Results: Of 184 records examined, 101 (55%) were seen by pediatric specialists and 83 (45%) by general emergency physicians. No significant differences in adherence to generally accepted fever guidelines were detected between general emergency physicians and pediatric emergency physicians. The violation rates were 38 of 101 (38%, 95% CI 28% to 48%) for pediatric specialists and 31 of 83 (37%; 95% CI 27% to 49%) for general emergency physicians; the 2 groups were not significantly different. Five of 38 (13%; 95% CI 4% to 28%) violations were related to inappropriate treatment. The other 33 of 38 (87%; 95% CI 72% to 96%) were omissions of indicated laboratory studies. Although there was a trend toward increased use of diagnostic studies by general emergency physicians, nothing approached statistical significance; however, the number of viral antigen studies ordered by general emergency physicians was of interest: pediatric emergency physicians 38% (95% CI 28% to 48%) versus general emergency medicine 52% (95% CI 41% to 63%). Disposition and management between general emergency physicians and pediatric emergency physicians also were similar: antibiotic administration rates for pediatric emergency physicians were 52% (95% CI 42% to 62%) versus general emergency physicians 48% (95% CI 37% to 59%), and hospital admission rates for pediatric emergency physicians were 19% (95% CI 12% to 28%) versus general emergency physicians 18% (95% CI 11% to 28%). Conclusion: In a busy practice where general emergency physicians are treating children alongside specialty-trained pediatric emergency physicians, the management of pediatric fever is equivalent. General emergency physicians do not differ from their pediatric emergency physicians colleagues in terms of deviation from published guidelines, disposition, or management of febrile children 0 to 36 months of age.

An audit of open and laparoscopic inguinal hernia repair

A retrospective case review to describe current practices and outcomes of patients undergoing inguinal hernia repair was undertaken in a principal referral hospital (John Hunter Hospital, Newcastle, New South Wales). The participants were patients who had elective laparoscopic or open inguinal hernia repair between 1 June 1997 and 31 May 1998. The main outcome measures were duration of surgery, type of anaesthesia, use of antibiotics, length of stay, postoperative complications, analgesic administration, and costs. Laparoscopic repair was advantageous in terms of length of stay and use of analgesia, but at a higher in theatre financial cost. Low rates of day stay surgery and use of local anaesthesia, and a high rate of antibiotic administration were apparent. It was concluded that local surgical practice has adopted some but not all advances described in the literature. Performance of a more expensive hernia repair in some patients may mitigate against performance of any repair in others.