Less is More: A Cost and Environmental Waste Analysis in Nonadherence to Antibiotic Prophylaxis Guidelines in Clean Ambulatory Surgical Procedures

Abstract

BackgroundAntibiotic misuse extends beyond clinical outcomes, imposing significant financial, operational, and environmental burdens on health care systems. Despite guidelines advising against antibiotic prophylaxis for elective low-risk laparoscopic operations, clean head and neck, and soft tissue procedures, many surgeons continue to use them. We performed a cost and environmental waste analysis at our institution resulting from nonadherence to guidelines.MethodsA retrospective chart review was performed at a single institution between January 2022 and March 2023. All patients undergoing elective diagnostic laparoscopy, soft tissue excisions for presumed benign disease, thyroid, and parathyroidectomy operations were included. Antibiotic costs were obtained from the hospital charge pharmacy. Waste was estimated by weighing the bottles and syringes used to administer the antibiotics.ResultsFrom January 2022 to March 2023, 137 patients who underwent the defined operations were identified. 38% (n = 52) underwent lipoma excisions, 33% (n = 46) thyroidectomy, 11% (n = 15) parathyroidectomy, 9% (n = 12) diagnostic laparoscopy, and 9% (n = 12) other soft tissue excision. 94% (n = 129) of cases were classified as clean and 6% (n = 8) were classified as clean-contaminated in the operative report. Prophylactic antibiotics were administered to 92% (n = 126) of patients, with 6% (n = 8) receiving an additional intraoperative dose. Cefazolin was used in 90% (n = 119) of cases, followed by Cefoxitin 1% (n = 1) and Clindamycin 1% (n = 1). Adherence to guidelines could have saved US$3279 and prevented £23 of waste.DiscussionA significant number of clean cases received prophylactic antibiotics, reflecting poor adherence to clinical practice guidelines. Improving antibiotic stewardship can reduce costs and environmental waste.