# Peri-operative antibiotic prophylaxis in obstetrics: a 6-year evaluation of guideline adherence and stewardship impact in a Ukrainian maternity hospital

## TL;DR

This study shows that improved antibiotic use in Ukrainian maternity hospitals led to better outcomes and shorter hospital stays over six years.

## Contribution

The study evaluates the impact of antimicrobial stewardship on guideline adherence and clinical outcomes in obstetric surgery over six years.

## Key findings

- Full compliance with PAP guidelines increased from 11% to 71% over six years.
- Mean length of hospital stay decreased from 9.9 to 4.7 days during the study period.
- Protocol adherence showed significant impact only in highly standardized laparoscopy procedures.

## Abstract

Surgical-site infections are a major concern in obstetric surgery. In Ukraine, evolving national guidelines and institutional antimicrobial stewardship (AMS) initiatives have sought to optimize peri-operative antibiotic prophylaxis (PAP), but their impact on clinical outcomes requires rigorous evaluation.

We conducted a retrospective cohort study (2018–2023) of 474 obstetric surgeries to evaluate changes in PAP adherence and its association with length of stay (LOS). Adherence was assessed using a 3-point compliance score (timing, choice, and duration). The association between compliance and time to discharge was analysed using a multi-variable Cox proportional hazards model.

A marked improvement in practice was observed; full compliance increased from 11% to 71%, while mean LOS decreased from 9.9 to 4.7 days. Component analysis showed that structural interventions eliminated duration errors, while errors in antibiotic choice persisted. In the multi-variable model, the ‘year of surgery’ was the strongest predictor of earlier discharge (P < 0.001), acting as a proxy for holistic systemic improvements. While the compliance score was not an independent predictor in the overall cohort, binary compliance showed a trend towards significance (P = 0.098), remaining statistically subordinate to secular trends. A significant association was found only in the highly standardized laparoscopy subgroup, suggesting the impact of protocol adherence is most visible in predictable clinical environments.

Multi-faceted AMS programs can successfully optimize PAP adherence and improve outcomes. While the overall reduction in LOS is driven by broad improvements over time, specific guideline adherence remains a crucial quality indicator, particularly for standardized procedures.