Study: Outpatient Surgical Infection Guidelines Adherence Improves With Ancillary Services Support

Timely discontinuation of antimicrobial prophylaxis following outpatient surgery is better achieved in higher complexity organizations with stronger infection prevention and antimicrobial stewardship services and support, according to a new study.

Published in Antimicrobial Resistance & Infection Control, the study examined more than 150,000 outpatient procedures in general surgery, urology, ophthalmology, otolaryngology (ENT) and orthopedics performed in Veterans Health Administration (VA) facilities. The procedures were performed at 70 higher complexity hospital outpatient departments (HOPDs), 41 lower complexity HOPDs and 22 ambulatory surgery centers (ASCs), also considered lower complexity, with complexity defined by the VA. Researchers identified which patients continued to receive antimicrobial prophylaxis lasting more than 24 hours after surgery.

Evidence-based guidelines, as the study notes, recommend discontinuation of antimicrobial prophylaxis within 24 hours after incision closure in uninfected patients. Unnecessary antimicrobial exposure, the researchers note, can lead to increases in postoperative adverse events.

Findings included the following:

  • About 7,700 patients (5.0%) received antimicrobial prophylaxis lasting more than 24 hours after surgery.

  • Highest rates were associated with cystoscopies and cystoureteroscopy with lithotripsy (16% and 20%, respectively).

  • Hernia repair, cataract surgeries and laparoscopic cholecystectomies had the lowest rates (0.2%-0.3%).

Furthermore, the researchers found that organizations with applicable ancillary services (e.g., infectious diseases, infection prevention, antimicrobial stewardship) typically found in higher complexity facilities leads to lower rates of postoperative prophylactic antimicrobial use and more guideline-consistent care compared to lower complexity facilities where such services are not often available or readily accessible.

The researchers conclude, "Lower complexity facilities with limited infection prevention and antimicrobial stewardship resources may be important targets for quality improvement. … Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ASCs and HOPDs in their efforts to improve this facet of patient safety."