Compliance of Perioperative Antibiotic Dosing and Surgical Site Infection Rate in Office-Based Elective Surgery

LaBove, Gabrielle; Davison, Steven P.; Jackson, Monica

doi:10.1097/gox.0000000000000704

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…We have already extensively studied and published on infection control in breast tissue. 32 , 33 Of course, the breast case becomes inherently colonized over the course of the surgical procedure; however, the sources of the infectious agents are the nipple ducts and axilla, not the instruments. We have found no evidence in the literature to suggest that changing instruments leads to a decrease in surgical site infection rates.…”

Section: Discussionmentioning

confidence: 99%

Precaution Costs: The Presumption of Breast Cancer Seeding and Its Impact on Surgical Expenditure

Caudill

Newman

Davison³

2020

Plastic and Reconstructive Surgery - Global Open

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Summary: As healthcare costs continue to rise at unsustainable rates (at an average rate of 5.5% a year), expenses without measurable outcomes need review. 1 In reconstructive surgery, empiric change of instruments between oncologic and reconstructive segments of surgery is one such practice. Breast surgery for ductal carcinoma in situ (DCIS), prophylaxis, and partial extirpation has little possible increase in seeding or implantation risk based on the literature. With undue extrapolation from higher risk cancers (such as ovarian), preventative practices of changing out trays, re-gloving, re-gowning, re-preparing, and re-draping between phases persist in operating rooms across the country. From real case costs, the additional expense of 2 surgical setups in the United States is conservatively estimated at $1232 per case, or over $125 million per year for this theoretical risk. Using implantation risk for core breast biopsies as a denominator, this cost is $1.65–$5.8 million per potential recurrence. This is an unacceptably high cost for hypothetical recurrence risk reduction, especially one that does not impact survival outcomes.

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Section: Discussionmentioning

confidence: 99%

Precaution Costs: The Presumption of Breast Cancer Seeding and Its Impact on Surgical Expenditure

Caudill

Newman

Davison³

2020

Plastic and Reconstructive Surgery - Global Open

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“…Preoperative phase Pain management planning—acute narcotic prescription medications are provided, appropriate to the severity of anticipated postoperative pain, with the expectation of prompt transitioning to OTC/non-opioids 70-73 Limited preoperative fasting, as per ASA 2016 Task Force Guidelines 85 Preoperative anxiolytics—gabapentin 86 1-2 hours prior, SSI prevention No shaving, clipping hair 87-92 immediately preoperative Preoperative hibicleanse showers 93 Preoperative nasal mupirocin 94 Single dose IV antibiotic prophylaxis, given 0-60 minutes prior to incision 54,95,96 Preoperative synergy: Clonidine 0.25 mg p.o 97 Immediately preoperative: Benadryl, supplemental oxygen, hydration, and phenergan. …”

Section: Eras Bl Protocolmentioning

confidence: 99%

“…SSI prevention No shaving, clipping hair 87-92 immediately preoperative Preoperative hibicleanse showers 93 Preoperative nasal mupirocin 94 Single dose IV antibiotic prophylaxis, given 0-60 minutes prior to incision 54,95,96 …”

Section: Eras Bl Protocolmentioning

confidence: 99%

An Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient BodyLift Surgery

Nuveen

Matthesen²,

Cox

et al. 2020

Am J Cosmet Surg

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The concept of enhanced recovery after surgery (ERAS) was developed in 2001 in order to create a multimodal, scientifically based approach to the development and audit of protocols for improving outcomes after surgical procedures. These protocols undergo constant evolution and evaluation toward the goal of quality of recovery. The BodyLift (BL) is the procedure that most comprehensively addresses the cosmetic needs of patients after massive weight loss (MWL). In the course of performing 136 consecutive outpatient BL surgeries over 7 years, we have developed a management protocol that has provided consistently high patient satisfaction, minimized frequent complications, and has documented 100% safety in all cases performed without deep vein thrombosis (DVT), transfusion and with 1 postoperative hospital admission. Each evidence-based component in the protocol was instituted to reduce risk of complications known to be most commonly associated with circumferential body contouring surgery. ERAS protocols are now widely used in many other surgical subspecialties. These protocols have the common goal of returning the patient to normal function as expeditiously as possible and are associated with decreased complications as well as shorter length-of-stay (LOS) and reduced costs. We have enumerated the many components of our protocol and aligned each with elements of an ERAS paradigm. In our retrospective review of 7 years of BL surgery (n = 136), this protocol has reduced both major and minor complications to previously unpublished levels. Our independently formulated ERAS protocol for outpatient BL surgery aligns closely with the ERAS concept, limiting surgical stress, thus reducing complications and affording a smooth and predictable perioperative experience. This is of importance for elective cosmetic surgery patients, who often have high expectations for an uneventful recovery and are unaccepting of potentially out-of-pocket costs associated with complications.

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“…A meta-analysis by Stijn et al, demonstrated the importance of timing of administration (30–60 minutes prior to incision time), selection of agent for specific microbes (narrow spectrum antibiotics) and duration of prophylaxis (single pre-operative dose or intraoperative re-dosing if indicated) in prevention of SSI [ 2 ]. Unfortunately, non-compliance to guidelines is still observed and prolonged use of antibiotics leads to an increase in SSI rates and increased antimicrobial resistance rates [ 3 – 5 ]. An antimicrobial resistance situation analysis in 2015 in Tanzania indicated the resistance of Streptococcis pnemoniae to Trimethoprim and Sulphamethoxazole had increased from 25% in 2006 to 80% in 2012.…”

Section: Introductionmentioning

confidence: 99%

Perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital in Tanzania

et al. 2021

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Background Surgical Site Infections are a major cause of morbidity and mortality among operated patients. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medication for a single patient. Few studies have shown qualitatively factors influencing this and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania. Objective To describe the perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital. Methods A qualitative study involving in-depth interviews with surgeons was conducted in English by the primary investigator. The interviews were audio-recorded and transcribed verbatim. Systematic text condensation by Malterud was used for data analysis. Findings Fourteen surgeons and obstetrics and gynaecologists participated. Their perceptions were summarized into three main categories: Inadequate data to support practice; one who sees the patient decides the antibiotic prophylaxis; prolonged antibiotic use for fear of unknown. The participants perceived that choice of antibiotic should be based on local hospital data for bacterial resistance pattern, however the hospital guidelines and data for surgical site infection rates are unknown. Fear of getting infection and anticipating complications led to prolonged antibiotics use. Conclusion The study provides an understanding of surgical antibiotic prophylaxis use and its implementation challenges. This was partly expressed by unavailability of local data and guidelines to enhance practice. To improve this, there is a need of guidelines that incorporates local resistance surveillance data and enhanced antibiotic stewardship programmes. A strong consideration should be placed into ways to combat the fears of surgeons for complications, as these significantly affect the current practise with use of surgical antibiotic prophylaxis.

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Compliance of Perioperative Antibiotic Dosing and Surgical Site Infection Rate in Office-Based Elective Surgery

Cited by 6 publications

References 27 publications

Precaution Costs: The Presumption of Breast Cancer Seeding and Its Impact on Surgical Expenditure

Precaution Costs: The Presumption of Breast Cancer Seeding and Its Impact on Surgical Expenditure

An Enhanced Recovery After Surgery (ERAS) Protocol for Outpatient BodyLift Surgery

Perceptions of surgeons on surgical antibiotic prophylaxis use at an urban tertiary hospital in Tanzania

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