A Canadian survey of prophylactic antibiotic use among hip-fracture patients

OBJECTIVE: To study how surgical prophylactic antibiotics (SPAs) were utili zed in the perioperative management of surgery for hip fractures. DESIGN: Retrospective chart review of randomly selected medical records. SETTING: Twenty-two hospitals (teaching, nonteaching, community, and large urban referral centers) from across Canada. PATIENTS: Patients admitted in 1990 with a diagnosis of hip fracture. METHODS: Complete medical records of 438 patients were examined; 352 cases who underwent surgical repair of a fractured hip with insertion of prosthet ic material were included in analysis. Perioperative SPA use was assessed b y abstracting the agent(s) chosen, dosages, time given with respect to the incision, and duration of postoperative use. Fourteen patient and process-o f-care variables related to SPA were examined. RESULTS: 247 (70%) of 352 cases did not receive a dose of SPA 2 hours preop eratively. Ten percent of preoperative SPA was administered either too earl y or during the procedure. In 91 (39%) of 231 cases receiving SPA, the firs t dose was not administered until the end of the procedure. Preoperative SP A consisted of a parenteral first-generation cephalosporin for 94% of cases . SPAs were continued more than 24 hours postoperatively in 78% of cases. Lack of a written order for SPA, being a nonteaching hospital, and shorter duration of surgical procedure were predictive of failure to receive SPA in an effective manner. CONCLUSIONS: Most hip-fracture-surgery patients did not receive effective a ntibiotic prophylaxis as required to prevent serious wound infections. This important variable can be included for surveillance, so that corrective me asures can be taken to assure effective prophylactic antibiotic administrat ion.