Abstract
Introduction: Postoperative infection rates following endoprosthetic surgery are currently around 11%. In comparison with routine orthopaedic infection rates (0.5–2.0%) this is high and warrants investigation. Antibiotic prophylaxis at the time of surgery has been proven to reduce postoperative infection rates. We are looking to see if this is being administered correctly.
Methods: We sought the records of 183 patients undergoing primary EPRs at the ROH within an 18 month period. We were unable to locate 57 (69%) leaving 126 to analyse. We recorded details of the surgeon conducting the operation, the perioperative antibiotics administered, and whether the patient developed a SSI postoperatively. We grouped the patients into three groups, those who received the correct regime as defined by the department (1.5g Cefuroxime at induction followed by 3 doses of 750mg Cefuroxime at 8, 16 and 24 hours post-op), those who received cefuroxime but in an incorrect regime and those not receiving cefuroxime. We further looked at the frequency individual surgeons were administering the correct antibiotics. Finally we applied a Chi-squared anaylsis to see if there was a significant difference in infection rates between those receiving the correct antibiotics and those not.
Results: 52 patients (41%) received cefuroxime in the correct regime, 27 (22%) received cefuroxime in an incorrect regime and 47 patients (37%) did not receive cefuroxime. The different surgeons at the hospital administered the correct regime in varying frequencies (0%–65%). Giving the correct antibiotic dose is associated with a reduction in the incidence of postoperative SSI (0.1> p> 0.05).
Discussion: A large proportion of EPRs are carried out without the recommended prophylactic antibiotic cover. The rate of correct antibiotic administration varies widely between surgeons from the same department. This lack of appropriate prescribing could be contributing to a high rate of postoperative infection and therefore needs addressing.
Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
