Inadequate timing of prophylactic antibiotics in orthopedic surgery. We can do better

Abstract

Background and purpose There are rising concerns about the frequency of infection after arthroplasty surgery. Prophylactic antibiotics are an important part of the preventive measures. As their effect is related to the timing of administration, it is important to follow how the routines with preoperative prophylactic antibiotics are working.

Methods In 114 consecutive cases treated at our own university clinic in Lund during 2008, the time of administration of preoperative prophylactic antibiotic in relation to the start of surgery was recorded from a computerized operation report. In 291 other cases of primary total knee arthroplasty (TKA), randomly selected from the Swedish Knee Arthroplasty Register (SKAR), the type and dose of prophylactic antibiotic as well as the time of administration in relation to the inflation of a tourniquet and to the start of surgery was recorded from anesthetic records.

Results 45% (95% CI: 36–54) of the patients operated in Lund and 57% (CI: 50–64) of the TKAs randomly selected from the SKAR received the preoperative antibiotic 15–45 min before the start of surgery. 53% (CI: 46–61) received antibiotics 15–45 min before inflation of a tourniquet.

Interpretation The inadequate timing of prophylactic antibiotics indicates that the standards of strict antiseptic and aseptic routines in arthroplasty surgery are falling. The use of a simple checklist to ensure the surgical safety may be one way of reducing infections in arthroplasty surgery.

Acknowledgements

AST: data analysis and preparation of manuscript. OR: study design, data selection, and preparation of manuscript. AW-D: collection and analysis of data, and preparation of manuscript. PG and SK: collection and analysis of data. LL: study design, data analysis, and preparation of manuscript.

We are grateful to the following organizations for financial support: the Swedish Association of Local Authorities and Regions; the Swedish Research Council (Medicine; 09509); the Medical Faculty of Lund University; Region Skåne; and the Foundation for Support of Disabled Persons in Skåne.

No competing interests declared.