ANTIBIOTIC-PROPHYLAXIS IN GASTRODUODENAL SURGERY

Background/Aims: In a retrospective process quality control trial, pro per use of antimicrobial prophylaxis in gastroduodenal operations acco rding to the standard guidelines was studied. Patients and Methods: A total of 132 consecutive adult patients (pts), who underwent gastroduo denal surgery in a University Hospital, were enrolled to this study pr otocol. There were 88 males and 44 females of with mean (+/-SD) age of 58.7 (+/-9.1) years old. The patients were divided into 4 groups base d on surgical antibiotic prophylaxis policy. Group A consisted of surg ical pts receiving appropriate antibiotic prophylaxis (a 2nd generatio n cephalosporin) when there was indication. Group B consisted of pts w ithout indication who did not receive prophylaxis, Group C pts who, al though antibiotic prophylaxis was indicated, were not given prophylaxi s, and Group D pts without indication who received prophylaxis. Result s: Of 132 pts examined appropriate antibiotic prophylaxis was received by 28 pts (21%) (Group A). In 62 pts (47%), antibiotic prophylaxis wa s not indicated and not administered (group B). On the contrary, in 42 pts (32%), although antibiotic prophylaxis was indicated, it was not given (Group C). No patient received prophylaxis without indication. T he following infections were found: wound infection (n=10), pneumonia (n=6), severe sepsis (n=2), urinary tract infection (n=2), and fever o f unknown origin (n=2). Where correct antibiotic prophylaxis policy wa s followed (groups A and B), 6 post-operative infections occurred (6.7 %), with a mean (+/-SD) hospital length of stay 14.4 (+/-3.2) days. In contrast, in the group with incorrect antibiotic prophylaxis policy ( group D), 16 infectious complications occurred (38%) (p=0.001), with a mean (+/-SD) hospital length of stay 22.5 (+/-4.4) days (p=0.001). To tal hospitalization costs were much higher in this group compared with Groups A and B (p=0.01). Mortality rate was 9.5% in Group D, while no death occurred in the other groups (p=0.01). Conclusion: Antimicrobia l prophylaxis policy is an important issue, targeting lower morbidity or avoidable costs.