Perioperative Antibiotic Administration Review: An Analysis of Outpatient Surgeries at OhioHealth Doctors Hospital

TL;DR

This study found that most outpatient surgeries at OhioHealth Doctors Hospital did not follow recommended timing for antibiotic administration, increasing the risk of surgical site infections.

Contribution

The study identifies significant gaps in antibiotic administration timing during outpatient surgeries and suggests system-level interventions to improve compliance.

Findings

Only 3.3% of patients received antibiotics within the recommended pre-incision time window.

IVP antibiotics had higher on-time administration rates (4.6%) compared to infusion-based ones (0.7%).

Orthopedic procedures showed the highest adherence (7.9%) among surgical specialties.

Abstract

Introduction: A vital part of preventing surgical site infections (SSIs) is perioperative antibiotic prophylaxis. Antibiotics must be administered within a certain window of time, usually 15 to 60 minutes prior to the surgical incision, for them to be effective. The most frequently utilized medication, cefazolin, can be administered quickly by intravenous push (IVP), but other medications, such as vancomycin and clindamycin, need longer infusion times. Antibiotic efficacy declines, and the risk of SSIs is increased when scheduling requirements are not followed. With special focus on time, dosage, and variation by surgery type, this study evaluates adherence to perioperative antibiotic administration guidelines in outpatient surgeries at OhioHealth Doctors Hospital.

Methods: This retrospective study was conducted at OhioHealth Doctors Hospital in Columbus, Ohio. Patients aged 18 and older who underwent outpatient surgery between January 1, 2018, and December 31, 2021, were included. A total of 448 cases were analyzed. Data were extracted from electronic medical records and reviewed to assess antibiotic type, administration timing, dosing accuracy (based on patient weight), and surgery type. Descriptive statistics and appropriate statistical tests, including chi-square and confidence intervals, were used for analysis.

Results: Antibiotics were given to just 3.3% of patients over the advised pre-incision period. Antibiotics offered via IVP had a greater probability of being delivered on schedule (4.6%) compared to those that needed infusion pumps (0.7%, p = 0.0446). The most frequently administered antibiotic was cefazolin (65.6%), with 88.8% of doses being appropriately weight-adjusted. Nonetheless, there were notable differences in timing protocol adherence by surgical specialty, with numerous specialties displaying 0% compliance and orthopedic procedures exhibiting the highest adherence at 7.9%.

Conclusion: Adherence to perioperative timing standards was concerningly inadequate, even though antibiotic selection and dosage were generally suitable. The findings point to a substantial workflow and protocol enforcement gap at the system level. Operational adjustments like real-time warnings, checklists integrated with electronic health records (EHRs), and simpler delivery techniques may increase adherence and reduce preventable SSIs. Future research is required to assess how these strategies influence patient outcomes.