Factors associated with adherence to prophylactic antibiotic therapy for elective general surgeries in Japan

Abstract

Objectives: To identify the factors associated with inappropriate antibiotic use during elective general surgeries. Design: Cross-sectional analysis of administrative dataset. Setting: Sixty two acute-care hospitals in Japan. Participants: Two thousand and three hundred and seventy-three patients who had undergone inguinal hernia repair, appendectomy or laparoscopic cholecystectomy in 2004 and 2005. Main Outcome Measures: The appropriateness of antibiotic prophylaxis was evaluated in terms of the drug-selection and treatment-duration guidelines used in Japan, and the factors associated with guideline adherence were examined by multivariate logistic regression analysis. Results: The adherence rates for drug selection and treatment duration were 53-84 and 38-68% depending on surgical procedures, respectively. Patient age, sex and risk factors for surgical-site infections were not associated with inappropriate use of antibiotics after adjustment of other factors. The large size of the hospitals was significantly associated with inappropriate antibiotic usage. In hospitals with high surgical volume, the treatment duration was appropriate while antibiotic selection was relatively consistent but not adherent to the guidelines, implicating the presence of local practice routines. Conclusions: Our results suggest that education and other methods should be used to encourage adherence to clinical guidelines on surgical antibiotic use, especially on duration of treatment. Increasing surgical volume may facilitate the standardization of clinical practice and improve the quality of health care. © The Author 2011. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.