Improvement in Antimicrobial Stewardship for Orthopaedics Procedures: A NSQIP Quality-Improvement Project

Area of Science:

• Pediatric Orthopaedic Surgery
• Antimicrobial Stewardship
• Global Health Threats

Background:

• Antimicrobial resistance poses a significant global health challenge.
• The institution's orthopaedic surgery department exceeded benchmarks for prolonged postoperative antibiotic prophylaxis (>24 hours).
• A targeted initiative was implemented to decrease the duration of postoperative antibiotics in pediatric orthopaedic patients.

Purpose of the Study:

• To reduce the incidence of prolonged postoperative antibiotic use (>24 hours) in pediatric orthopaedic surgery patients.
• To improve antibiotic stewardship within the institution's orthopaedic department.

Main Methods:

• An interdisciplinary team developed and monitored interventions.
• Interventions included staff education on limiting antibiotic doses to two and modifying electronic health record order sets to default to two doses.
• Data on antibiotic duration and surgical site infections (SSIs) were tracked via an electronic dashboard and the National Surgical Quality-Improvement Pediatric Program (NSQIP-P) database.

Main Results:

• A total of 2,546 cases were analyzed (1,680 pre-intervention, 866 post-intervention).
• The percentage of patients receiving <24 hours of postoperative antibiotics increased from 36.7% to 84.7% (a 48.0% improvement).
• No significant increase in surgical site infections was observed post-intervention.

Conclusions:

• The National Surgical Quality-Improvement Pediatric Program (NSQIP-P) is a valuable tool for enhancing antibiotic stewardship in pediatric orthopaedic surgery.
• Multidisciplinary collaboration, staff education, EMR order set modifications, and real-time data feedback were key to achieving significant improvements in antibiotic use.