Implementation of a penicillin allergy protocol in open abdominal wall reconstruction: Preoperative optimization...

Area of Science:

• Surgery
• Infectious Diseases
• Quality Improvement

Background:

• Beta-lactam prophylaxis is standard for open abdominal wall reconstruction, but penicillin allergy (PA) often leads to non-β-lactam use.
• Non-β-lactam prophylaxis is associated with increased wound complications, readmissions, and reoperations in these patients.
• A quality improvement initiative implemented a penicillin allergy protocol to stratify risk and increase β-lactam prophylaxis for PA patients.

Purpose of the Study:

• To evaluate the impact of a penicillin allergy protocol on open abdominal wall reconstruction outcomes.
• To determine if the protocol could safely increase the use of β-lactam prophylaxis in patients with penicillin allergy.
• To assess the effect on surgical site infections, wound complications, reoperations, and readmissions.

Main Methods:

• A prospective evaluation of patients with penicillin allergy undergoing open abdominal wall reconstruction before and after protocol implementation.
• Patients were grouped based on protocol implementation date (pre-January 1, 2020 vs. post-January 1, 2020 to November 1, 2023).
• Primary outcome was surgical site infection incidence; secondary outcomes included wound complications, reoperations, and readmissions. Statistical analyses were performed.

Main Results:

• The post-protocol group (n=65) received significantly more β-lactam prophylaxis (83.1% vs. 22.8%) compared to the pre-protocol group (n=250).
• Post-protocol implementation showed significantly fewer surgical site infections (3.1% vs. 24.4%), wound breakdown (3.1% vs. 16.0%), reoperations (0.0% vs. 19.2%), and readmissions (9.2% vs. 25.3%).
• No antibiotic-induced allergic reactions were noted in the post-protocol group; recurrence rates were similar (1.5% vs. 8.4%).

Conclusions:

• The penicillin allergy protocol effectively and safely increased β-lactam prophylaxis use in patients with penicillin allergy undergoing open abdominal wall reconstruction.
• Implementation of the protocol led to significant reductions in surgical site infections, wound complications, reoperations, and readmissions.
• These findings support systemwide adoption of the penicillin allergy protocol for surgical patients with penicillin allergy.