PRESCRIBING PRACTICE AND COST OF ANTIBACTERIAL PROPHYLAXIS FOR SURGERY AT A US VETERANS AFFAIRS HOSPITAL

This study retrospectively compared the actual drug-related cost of an tibacterial prophylaxis for specific operative procedures with the the oretical costs based on recommendations published in Medical Letter on Drugs and Therapeutics, the Surgical infection Society, and those of the chiefs of each surgical subspecialty at our institution. We identi fied all inpatients who received an intravenous antibacterial for prop hylaxis before a clean or clean-contaminated operation between 1st Jan uary and 30th September 1993, using the medical centre's computerised information system. The information included comprehensive surgical ca se histories, and pharmacy and microbiology records. Only those operat ions in which recommendations for surgical prophylaxis were present in all 3 guidelines were included. The outcome measures were antibacteri al-related costs (drug acquisition and administration cost), the numbe r of antibacterial doses dispensed, and choice of antibacterial agents . During the study period, 3322 operations were performed, 2993 of whi ch were excluded. Thus, 329 patients undergoing operations in 6 subspe cialties were included in the analysis. The actual mean cost per patie nt significantly exceeded the projected costs using Medical Letter Con sultants' and Surgical Infection Society guidelines for all 6 subspeci alties [mean excess cost per patient: $US49.04 and $US34.95, respectiv ely (1994 values)] and institutional guidelines for 4 of the 6 subspec ialties (mean excess cost per patient: $US24.36). The actual mean numb er of doses per patient significantly exceeded those projected using M edical Letter Consultants' and Surgical Infection Society guidelines f or all 6 subspecialties (mean excess number of doses per patient: 6.0 and 4.0, respectively) and institutional guidelines for 3 of the 6 sub specialties (mean excess number of doses per patient: 2.9). The choice of antibacterial was appropriate in approximately 90% of cases. We co nclude that the practice of antibacterial prophylaxis for specific ope rative procedures performed by 6 subspecialties is not in accordance w ith institutional or published guidelines, and the excess cost is prim arily a result of prolonged duration of antibacterial prophylaxis.