Background
The Surgical Care Improvement Program endorses mandatory compliance with approved intravenous prophylactic antibiotics, however oral antibiotics are optional. We hypothesized that SSI may vary depending on the choice of antibiotic prophylaxis.
Study Design
A retrospective cohort study of elective colorectal procedures utilizing Veterans Affairs Surgical Quality Improvement Program (VASQIP) and SSI outcome data was linked to the Office of Informatics and Analytics (OIA) and Pharmacy Benefits Management (PBM) antibiotic data from 2005-2009. SSI rates by type of IV antibiotic agent alone (IV) or in combination with oral antibiotic (IV+OA) were determined. Generalized estimating equations (GEE) were used to examine the association between type of antibiotic prophylaxis and SSI for the entire cohort and stratified by use of oral antibiotics.
Results
Following 5,750 elective colorectal procedures, 709 (12.3%) developed an SSI within 30 days. OA+IV (n=2,426) had a lower SSI rate than IV alone (n=3,324) (6.3% vs. 16.7%, p < 0.0001). There was a significant difference in the SSI rate based on type of preoperative IV antibiotic given (p=< 0.0001). GEE adjusting for significant covariates of age, BMI, procedure work RVU, , and operation duration demonstrated an independent protective effect of OA (OR=0.37, 95% CI 0.29-0.46), as well as increased rates of SSI associated with ampicillin/sulbactam (OR: 2.21, 95% CI 1.37-3.56) and second generation cephalosporins (cefoxitin: OR=2.50, 95% CI 1.83-3.42; cefotetan: OR= 2.70, 95% CI 1.72-4.22) when compared to first generation cephalosporin/metronidazole.
Conclusions
The choice of IV antibiotic was related to the SSI rate, however, oral antibiotics were associated with reduced SSI rate for every antibiotic class.
Rhiannon J. Deierhoi, MPH, Lillian G. Dawes, MD, FACS, Catherine Vick, MS, Kamal MF. Itani, MD, FACS, Mary T. Hawn, MD, MPH, FACSemail address
Received 1 May 2013; received in revised form 30 May 2013; accepted 1 July 2013. published online 10 July 2013. Journal of the American College of Surgeons
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