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[Do guidelines bring an improvement in the perioperative course? A study of perioperative antibiotic prophylaxis]
U Wolters1, M Schrappe, D Möhrs
1Klinik und Poliklinik für Visceral- und Gefässchirurgie, Universität Köln. Ulrich.Wolters@Medizin.Uni-Koeln.de
Introduction:
Although the effectiveness of perioperative antibiotic prophylaxis is proven, it is not used adequately. The aim of this study was to evaluate whether hospital-based guidelines are useful tools to improve the management of perioperative antimicrobial prophylaxis.
Material:
In a retrospective study the actual quality of perioperative antibiotic prophylaxis as given by the criteria choice of drugs, dosage, timing, continuation and 2nd dose after > 3 h was evaluated. After information and establishment of adequate guidelines we started a prospective analysis to test compliance and rate of adequate prophylaxis. Differences were calculated according to the chi 2-test with P < 0.05 significance niveau.
Results:
The percentage of cases in which antibiotics were indicated but not administered was reduced from 15.5% to 8.4%. Compared to the result of the retrospective analysis, the prospective study showed a significantly higher percentage of adequately administered antibiotics (35.7% vs. 63.5%). This was mainly due to the compliance with dosage recommendations and to the 2nd dose in longer surgical procedures.
Discussion:
Guidelines lead to a significant improvement in perioperative antibiotic prophylaxis. To increase this effect, further approaches such as integration of guidelines into computer-based systems should be evaluated.