Timing is everything when it comes to improving financial efficiency and boosting quality of care by maximizing the efficacy of antibiotics administered before and after surgery, according to new consensus guidelines.
The guidelines, published in the June 15 issue of Clinical Infectious Diseases, were the result of a yearlong effort by a consortium of surgical and professional societies, the VHA, several universities and several government agencies, including the CMS and the Centers for Disease Control and Prevention.
Their work indicates money can be saved by forgoing the cost of squandered anti-biotics delivered too late to be effective, as well as by minimizing the added costs of treating patients with hospital-acquired infections when antibiotics are administered too late.
Study co-author Dale Bratzler, D.O., is the principal clinical coordinator for the Oklahoma Foundation for Medical Quality, which contracted with the CMS to coordinate the research. Bratzler said work group members first reviewed the existing guidelines.
"We noticed when we looked at some of the guidelines there were some discrepancies and that some things weren't addressed," Bratzler said.
Surgical-site infections are the second-most common cause of hospital infections, with more than 500,000 occurring in the U.S. each year, according to the authors, who cited CDC data.
On average, each infection adds seven days to a hospital stay and costs $3,000 to $5,000 per incident. In severe cases-say an infection following hip surgery that requires replacement of the entire implant-the cost can soar to more than $50,000, said John Hitt, M.D., a study group member.
The importance of timing in administering antibiotics is nothing new, Hitt said, with some research dating back to the 1960s.
"There is lots of data that shows you have to give it at the right time before surgery and you have to have it on board during surgery," said Hitt, vice president of clinical affairs and improvement for VHA. Hitt is an internist with a specialty in infectious diseases.
Hitt, Bratzler and other members of the work group examined best practices in five surgical areas: cardiothoracic, vascular, colon, hip or knee replacement and vaginal or abdominal hysterectomy.
They recommended that antibiotics be given one hour before surgery and not be used more than 24 hours after the end of the operation.
Only about 55% of surgical patients receive antibiotics within an hour of surgery, and they are administered for an average of 40 hours after the procedure-in some instances as long as 96 hours after surgery.
Supplying the medications too soon can sometimes lead to weakened efficacy because of the half-life of certain antibiotics, Hitt said. Supplying them for too long after surgery simply wastes drugs and money.
"Anytime you use an unnecessary drug, that's flushing money down the toilet," Hitt said. And while antibiotics are fairly in-expensive, "You multiply that times a number of surgeries a year and it starts to amount to real money. We did some calculations for some of our hospitals; it's multiple thousands of dollars even for small hospitals."
More than a dozen professional societies have endorsed the guidelines.
