OBJECTIVES

Preoperative Antibiotic (ABX) prophylaxis (PPX) reduces the likelihood of post-operative surgical site infection (SSI). In 2017, national guidelines were changed to recommend no post-operative ABX PPX for clean and clean-contaminated surgeries. Inappropriate use of post-operative ABX PPX provides no added clinical benefit and has been linked to direct patient harm, including allergic reactions (including anaphylaxis), bacterial resistance, and Clostridioides difficile infection. Guideline adherence could result in both improved patient outcomes and overall cost-savings to health systems.

We analyzed existing economic and clinical evidence to quantify the potential direct medical cost consequences of inappropriate post-operative ABX PPX in clean and clean-contaminated surgeries compared to no post-operative ABX PPX use.

METHODS

A decision tree model of expected costs for each ABX strategy was created based on review of the existing literature. A U.S. hospital costing perspective was used (all costs updated to 2018 US$). The time horizon for adverse outcomes was 48-72 hours after surgical incision closure. Currently, nearly all such surgeries typically receive at least 24 hours of antibiotic post-operatively. The most common post-operative ABX regimens; cefazolin, clindamycin, vancomycin, ciprofloxacin/levofloxacin, were compared to NO post-operative ABX PPX administered. The analysis included post-surgical expected costs for drugs, drug-related adverse events and other treatment complications.

RESULTS

The expected medical costs per patient are: for cefazolin -- $6141, clindamycin -- $7949, vancomycin -- $6550, ciprofloxacin $14597, and NO ABX agent -- $1978.

The NO post-operative ABX strategy saves an average per patient cost of $6,832. U.S. data show approximately 12 million inpatient clean and clean-contaminated surgeries annually. The potential annual savings in reduced hospital costs alone could thus exceed $76 billion.

CONCLUSIONS

Full guideline adherence with NO post-operative prophylaxis will generate substantial hospital savings for clean and clean-contaminated surgeries, in addition to improving health outcomes and reducing risk of bacterial drug resistance.