Archives of Surgery.

140(2):174-182, February 2005

Use of Antimicrobial Prophylaxis for Major Surgery: Baseline Results From the National
Surgical Infection Prevention Project
Bratzler, Dale W. DO, MPH; Houck, Peter M. MD; Richards, Chesley MD, MPH; Steele, Lynn
MS, CIC; Dellinger, E. Patchen MD; Fry, Donald E. MD; Wright, Claudia MS; Ma, Allen PhD;
Carr, Karina RN; Red, Lisa MSHA
Institution
Oklahoma Foundation for Medical Quality, Inc, Oklahoma City (Drs Bratzler and Ma and Mss
Wright, Carr, and Red); Centers for Medicare & Medicaid Services (CMS), Seattle, Wash (Dr
Houck); Division of Healthcare Quality Promotion, National Center for Infectious Diseases (Dr
Richards), and Office of the Director (Ms Steele), Centers for Disease Control and Prevention,
Atlanta, Ga; and Departments of Surgery, University of Washington, Seattle (Dr Dellinger); and
University of New Mexico, Albuquerque (Dr Fry).
Abstract
Hypothesis: Surgical 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.
Design: National retrospective cohort study with medical record review.
Setting: Two thousand nine hundred sixty-five acute-care US hospitals.
Patients: A 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 Measures: The 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.
Results: An 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.

Conclusion: Substantial opportunities exist to improve the use of prophylactic antimicrobials for
patients undergoing major surgery.
Copyright 2005 by the American Medical Association. All Rights Reserved. Applicable
FARS/DFARS Restrictions Apply to Government Use. American Medical Association, 515 N.
State St, Chicago, IL 60610
Author Keywords
Antibiotic Prophylaxis; Surgical Wound Infection.
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