Appropriateness and pharmacoeconomics of surgical antimicrobial prophylaxis in open reduction internal fixation surgery practiced in a tertiary hospital compared to recommendations in the national center for disease control guidelines

Abstract

Context: Surgical site infections are frequently observed despite the availability of national guideline on surgical antimicrobial prophylaxis (SAP). These infections increase patient morbidity, mortality, and direct and indirect health-care costs. Open reduction internal fixation (ORIF) is a common orthopedic surgery for fracture. There is a paucity of Indian data on SAP in ORIF surgery. Aims: The present study was taken up aiming at the evaluation of appropriateness and pharmacoeconomics of SAP in ORIF based on the national guidelines. Subjects and Methods: One-year observational prospective cohort study was conducted among 412 participants, who underwent ORIF in the Department of Orthopedics in a Tertiary Care Hospital. Name, dose, route, timing, frequency, and duration of administration of prophylactic antimicrobials used were recorded. Statistical Analysis Used: Descriptive statistics were used wherever required. Results: The mean age of participants was 39.24 years, majority (60.92%) were male, and 49.52% had fracture of lower-limb bones. The appropriateness of preoperative SAP in terms of indication in ORIF, timing, and route of administration was 100%. Selection and dose of preoperative and postoperative antimicrobials were appropriate in only 13% of cases. Omission of intraoperative dose was appropriate in all participants. Duration of postoperative Antimicrobial agent administration was inappropriately long in all participants. None of the cases received completely appropriate regimen. Cost analysis showed the mean cost of SAP practiced in our hospital was eleven times higher than that with recommended SAP. Conclusions: Considering the inappropriateness of SAP practiced, monitoring of guideline implementation and awareness among health-care professionals are necessary to prevent SSI and to decrease economic burden on the patients.