• Dale W Bratzler, Peter M Houck, Chesley Richards, Lynn Steele, Dellinger E Patchen EP, Donald E Fry, Claudia Wright, Allen Ma, Karina Carr, and Lisa Red.
• Oklahoma Foundation for Medical Quality, Inc, Oklahoma City, OK 73134-2627, USA. dbratzler@okqio.sdps.org
• Arch Surg Chicago. 2005 Feb 1; 140 (2): 174-82.

HypothesisSurgical site infections (SSIs) are a major contributor to patient injury, mortality, and health care costs. Despite evidence of effectiveness of antimicrobials to prevent SSIs, previous studies have demonstrated inappropriate timing, selection, and excess duration of administration of antimicrobial prophylaxis. We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery.DesignNational retrospective cohort study with medical record review.SettingTwo thousand nine hundred sixty-five acute-care US hospitals.PatientsA systematic random sample of 34,133 Medicare inpatients undergoing coronary artery bypass grafting; other open-chest cardiac surgery (excluding transplantation); vascular surgery, including aneurysm repair, thromboendarterectomy, and vein bypass operations; general abdominal colorectal surgery; hip and knee total joint arthroplasty (excluding revision surgery); and abdominal and vaginal hysterectomy from January 1 through November 30, 2001.Main Outcome MeasuresThe proportion of patients who had parenteral antimicrobial prophylaxis initiated within 1 hour before the surgical incision; the proportion of patients who were given a prophylactic antimicrobial agent that was consistent with currently published guidelines; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery.ResultsAn antimicrobial dose was administered to 55.7% (95% confidence interval [CI], 54.8%-56.6%) of patients within 1 hour before incision. Antimicrobial agents consistent with published guidelines were administered to 92.6% (95% CI, 92.3%-92.8%) of the patients. Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7% (95% CI, 40.2%-41.2%) of patients.ConclusionSubstantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery.

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